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Risk Factors and Causes of Delayed Hip Fracture Surgery in Elderly Patients: Findings from a Hip Fracture Fast-Track
Chanon Hansudewechakul1, Natee Tanasubsinn, Sakdichot Aerthada
1From the Orthopedic Department (Dr. Hansudewechakul, Dr. Tanasubsinn, Dr. Roobsoong), Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, and the Srisangworn Sukhothai Hospital (Dr. Aerthada), Sukhothai, Thailand.
Summary
Delayed hip fracture surgery in elderly patients is common, affecting over a third. Key factors include multiple comorbidities, anemia, and weekend admissions, leading to poorer outcomes.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Health Services Research
Background:
- Early surgical intervention (within 48 hours) for hip fractures in elderly patients is crucial for optimal outcomes.
- Despite established fast-track protocols, surgical delays remain a significant challenge in this population.
Purpose of the Study:
- To investigate the incidence and risk factors associated with delayed hip fracture surgery in elderly patients.
- To identify system-related and patient-related causes contributing to surgical delays within a Hip Fast-Track (HFT) care model.
Main Methods:
- Retrospective cohort study of elderly hip fracture patients (October 2022 - September 2024).
- Patients classified as urgent (<48 hours) or delayed (>48 hours) surgery.
- Descriptive and multivariable statistical analyses were employed to identify risk factors and causes of delay.
Main Results:
- A significant proportion (33.85%) of 390 patients experienced delayed surgery (>48 hours).
- Independent risk factors for delay included ≥3 comorbidities (OR=2.34), anemia/need for transfusion (OR=2.90), and admission on Thursday/Friday (OR=3.92).
- Delayed surgery correlated with longer hospital stays and increased rates of urinary tract infections and pressure ulcers.
Conclusions:
- Timely hip fracture surgery requires optimizing preoperative preparation, especially for patients with multiple comorbidities.
- Enhancing preoperative anemia management and blood transfusion services is essential.
- Ensuring surgical service continuity, including during public holidays, is critical to reduce delays.
