Early surgery? In-house mortality after proximal femoral fractures does not increase for surgery up to 48 h after admission.
Complications
Early surgery
Mortality rate
Proximal femur fracture
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
08
02
2023
accepted:
31
03
2023
medline:
23
5
2023
pubmed:
4
5
2023
entrez:
3
5
2023
Statut:
ppublish
Résumé
The economic cost linked to the increasing number of proximal femur fracture and their postoperative care is immense. Mortality rates are high. As early surgery is propagated to lower mortality and reduce complication rates, a 24-h target for surgery is requested. It was our aim to determine the cut-off for the time to surgery from admission and therefore establish a threshold at which the in-house mortality rate changes. A retrospective single-center cohort study was conducted including 1796 patients with an average age of 82.03 years treated operatively for a proximal femoral fracture between January 2016 and June 2020. A single treatment protocol was performed based on the type of anticoagulant, surgery, and renal function. Patient data, surgical procedure, time to surgery, complications, and mortality were assessed. In-house mortality rate was 3.95%, and the overall complication rate was 22.7%. A prolonged length of hospital stay was linked to patient age and occurrence of complications. Mortality is influenced by age, number of comorbidities BMI, and postoperative complications of which the most relevant is pneumonia. The mean time to surgery for the entire cohort was 26.4 h. The investigation showed no significant difference in mortality rate among the two groups treated within 24 h and 24 to 48 h while comparing all patients treated within 48 h and after 48 h revealed a significant difference in mortality. Age and number of comorbidities significantly influence mortality rates. Time to surgery is not the main factor influencing outcome after proximal femur fractures, and mortality rates do not differ for surgery up to 48 h after admission. Our data suggest that a 24-h target is not necessary, and the first 48 h may be used for optimizing preoperative patient status if necessary.
Identifiants
pubmed: 37138145
doi: 10.1007/s40520-023-02406-x
pii: 10.1007/s40520-023-02406-x
pmc: PMC10156577
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1231-1239Informations de copyright
© 2023. The Author(s).
Références
Kannus P, Parkkari J, Sievänen H et al (1996) Epidemiology of hip fractures. Bone 18:57S-63S
doi: 10.1016/8756-3282(95)00381-9
pubmed: 8717549
Melton LJ (1996) Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18:121S-125S. https://doi.org/10.1016/8756-3282(95)00492-0
doi: 10.1016/8756-3282(95)00492-0
pubmed: 8777076
Tajeu GS, Delzell E, Smith W et al (2014) Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci 69A:346–353
doi: 10.1093/gerona/glt105
Rupp M, Walter N, Pfeifer C et al (2021) The incidence of fractures among the adult population of Germany—an analysis from 2009 through 2019. Dtsch Arztebl Int 118:665–669. https://doi.org/10.3238/arztebl.m2021.0238
doi: 10.3238/arztebl.m2021.0238
pubmed: 34140088
pmcid: 8727861
Hernlund E, Svedbom A, Ivergard M et al (2013) Osteoporosis in the European union: medical management, epidemiology and economic burden. Arch Osteoporos 8:136
doi: 10.1007/s11657-013-0136-1
pubmed: 24113837
pmcid: 3880487
Kempenaers K, Van Calster B, Vandoren C et al (2018) Are the current guidelines for surgical delay in hip fractures too rigid? A single center assessment of mortality and economics. Injury 49:1169–1175. https://doi.org/10.1016/j.injury.2018.03.032
doi: 10.1016/j.injury.2018.03.032
pubmed: 29609969
Holt G, Smith R, Duncan K et al (2009) Changes in population demographics and the future incidence of hip fracture. Injury 40:722–726
doi: 10.1016/j.injury.2008.11.004
pubmed: 19426972
Richtlinie des Gemeinsamen Bundesausschusses über Maßnahmen zur Qualitätssicherung zur Versorgung von Patienten mit einer hüftgelenknahen Femurfraktur gemäß § 136 Absatz 1 Satz 1 Nummer 2 für nach § 108 SGB V zugelassene Krankenhäuser. https://www.g-ba.de/downloads/62-492-2953/QSFFx-RL_2022-06-16_iK-2022-09-30.pdf ; 23.10.2022
Bohm E, Luocks L (2015) Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority. Can J Surg 58:257–263
doi: 10.1503/cjs.017714
pubmed: 26204364
pmcid: 4512868
Al-Ani AN, Samuelsson B, Tidermark J et al (2008) Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Jt Surg Am 90:1436–1442
doi: 10.2106/JBJS.G.00890
Uzoigwe CE, Burnand HG, Cheesman CL et al (2013) Early and ultraearly surgery in hip fracture patients improves survival. Injury 44:726–729
doi: 10.1016/j.injury.2012.08.025
pubmed: 23010072
Saul D, Riekenberg J (2019) Hip fractures: therapy, timing, and complication spectrum. Orthop Surg 11:994–1002
doi: 10.1111/os.12524
pubmed: 31568676
pmcid: 6904609
Leung F, Lau TWK (2010) Does timing of surgery matter in fragility hip fractures. Osteoporos Int 21:S529–S534. https://doi.org/10.1007/s00198-010-1391-2
doi: 10.1007/s00198-010-1391-2
pubmed: 21057992
Khan SK, Kalra S, Khanna A et al (2009) Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 40:692–697
doi: 10.1016/j.injury.2009.01.010
pubmed: 19450802
Simunovic N, Devereaux PJ, Sprague S et al (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616. https://doi.org/10.1503/cmaj.092220
doi: 10.1503/cmaj.092220
pubmed: 20837683
pmcid: 2952007
Moran CG, Wenn RT, Sikand M et al (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Jt Surg Am 87:483–489. https://doi.org/10.2106/JBJS.D.01796
doi: 10.2106/JBJS.D.01796
Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
ASA Physical Classification System. American society of anesthesiologists. Available at http://www.asahq.org/Home/For-Members/Clincal-Information/ASA-Physical-Status-Classification-System/31.01.2023
Welford P, Jones CS, Davies G et al (2021) The association between surgical fixation of hip fractures within 24 hours and mortality: a systematic review and meta-analysis. Bone Jt J 103-B:1176–1186. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2582.R1
doi: 10.1302/0301-620X.103B7.BJJ-2020-2582.R1
Grimes JP, Gregory PM, Noveck H et al (2002) The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 112:702–709
doi: 10.1016/S0002-9343(02)01119-1
pubmed: 12079710
Maheshwari K, Planchard J, You J et al (2018) Early surgery confers 1-year mortality benefit in hip-fracture patients. J Orthop Trauma 32:105–110. https://doi.org/10.1097/BOT.0000000000001043
doi: 10.1097/BOT.0000000000001043
pubmed: 29065037
Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951. https://doi.org/10.1136/bmj.38790.468519.55
doi: 10.1136/bmj.38790.468519.55
pubmed: 16554334
pmcid: 1444867
Frölich Frandsen C, Glassou EN, Stilling M et al (2022) Malnutrition, poor function and comorbidities predict mortality up to one year after hip fracture: a cohort study of 2800 patients. Eur Geriatr Med 13:433–443
doi: 10.1007/s41999-021-00598-x
Cher EWL, Allen JC, Howe TS et al (2019) Comorbidity as the dominant predictor of mortality after hip fracture surgeries. Osteoporos Int 30:2477–2483
doi: 10.1007/s00198-019-05139-8
pubmed: 31451838
Switzer JA, Bennett RE, Wright DM et al (2013) Surgical time of day does not affect outcome following hip fracture fixation. Geriatric Ortho Surg Rehab 4:109–116
doi: 10.1177/2151458513518344
Smektala R, Endres HG, Dasch B et al (2008) The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord 9:171. https://doi.org/10.1186/1471-2474-9-171
doi: 10.1186/1471-2474-9-171
pubmed: 19114019
pmcid: 2627842
Perez JV, Warwick DJ, Case CP et al (1995) Death after proximal femoral fracture–an autopsy study. Injury 26:237–240. https://doi.org/10.1016/0020-1383(95)90008-l
doi: 10.1016/0020-1383(95)90008-l
pubmed: 7649622
Leer-Salvesen S, Engesæter LB, Dybvik E et al (2019) Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian hip fracture register. Bone Joint J 101-B:1129–1137. https://doi.org/10.1302/0301-620X.101B9.BJJ-2019-0295.R1
doi: 10.1302/0301-620X.101B9.BJJ-2019-0295.R1
Bennett A, Li H, Patel A et al (2018) Retrospective analysis of geriatric patients undergoing hip fracture surgery: delaying surgery is associated with increased morbidity, mortality, and length of stay. Geriatr Orthop Surg Rehabil. https://doi.org/10.1177/2151459318795260
doi: 10.1177/2151459318795260
pubmed: 30245906
pmcid: 6146322
Aprato A, Casiraghi A, Pesenti G et al (2019) 48 h for femur fracture treatment: are we choosing the wrong quality index? J Orthop Traumatol 20:11. https://doi.org/10.1186/s10195-019-0518-2
doi: 10.1186/s10195-019-0518-2
pubmed: 30758673
pmcid: 6375274