Impact of time to surgery in upper femoral fracture in orthogeriatrics.
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
/ methods
Female
France
/ epidemiology
Health Services for the Aged
/ organization & administration
Hip Fractures
/ epidemiology
Hospitalization
Humans
Male
Morbidity
/ trends
ROC Curve
Retrospective Studies
Survival Rate
/ trends
Time-to-Treatment
Elderly patients
Hip fracture
Orthogeriatric department
Time to surgery
Journal
Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
28
01
2018
revised:
24
01
2019
accepted:
23
04
2019
pubmed:
16
7
2019
medline:
14
4
2020
entrez:
15
7
2019
Statut:
ppublish
Résumé
Treatment of hip fracture in the elderly is a major public health issue. Orthogeriatric departments have been developed for these patients at high risk of complications. Time to surgery seems to be an important factor in the care pathway, but remains controversial. The aim of this study was to assess the impact of less than 24 hours' time to surgery on 1-year morbidity and mortality in patients managed in our orthogeriatric department. The study hypothesis was that<24 hours' time to surgery decreases mortality in elderly patients with upper femoral fracture. A retrospective cohort study from September 2015 to July 2016 included patients aged 75 years and older, eligible for orthogeriatric management of upper femoral fracture. Patients with comorbidities were prioritized for admission and for access to the operating room. Time to surgery was defined as time between the arrival in A&E and transfer to the operating room. The primary endpoint was 1-year survival. Comorbidities were assessed on Charlson score. ROC curve analysis determined the optimal cut-off for time to surgery. Variables significantly associated with mortality were included in a Cox regression model to estimate the adjusted effect of time to surgery on mortality. One hundred and eight patients were included; mean age, 87±6.2 years; 26 male (24.1%), 82 female (75.9%). One-year mortality was 24.1% (26/108). Mean time to surgery was 14.1±30.9hours. ROC curve analysis showed a rise in mortality after a cut-off of 22hours 37minutes (p<0.0001). Within a dedicated orthogeriatric department, time to surgery is a significant factor in the management of hip fractures in the elderly. Patients should be prioritized for theater and ideally receive "early" surgery within 24hours of admission to A&E. The potential benefit of "ultra-early" surgery (time to surgery<6hours) requires robust assessment. IV, Retrospective cohort study.
Identifiants
pubmed: 31301997
pii: S1877-0568(19)30179-3
doi: 10.1016/j.otsr.2019.04.018
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
975-978Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.