Original Article

Time to Hip Fracture Surgery and Mortality

Authors: Kacy Clinkenbeard, PA-C, Kristyn Bossle, PA-C, Tyler Pape, PA-C, Leslie N. Woltenberg, PhD, Sibu Saha, MD

Abstract

Objective: This retrospective study explored the impact of time to surgery in acute hip fractures and outcomes in patients with acute hip fractures at a level I trauma center within an academic medical center in the southeastern United States. The objective was to explore the association between time to surgery and 30-day mortality and outcomes in adults 65 years and older undergoing hip fracture surgery for traumatic injuries in 2014–2019.

Methods: The population of this study consisted of patients who presented with a hip fracture and required operative measures. The research team conducted a secondary data analysis of medical records among patients who experienced a hip fracture and subsequent hip surgery to address the injury.

Results: Results from this study demonstrated a statistically significant relationship between a delay in surgery and an increase in postoperative complications and morbidity, as well as increased morbidity among male patients.

Conclusions: Incidence of hip fractures is increasing among older adult patients and is cause for concern because of an associated high mortality rate and risk of postoperative complications. The existing body of literature indicates earlier surgical intervention may improve outcomes and reduce postoperative complications and mortality. The results of this study affirm these findings and suggest further examination specifically among males.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Cheng SY, Levy AR, Lefairvre KA, et al. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int 2011; 22:2575–2586.
 
2. American Academy of Orthopaedic Surgeons. Management of hip fracture in the elderly: evidence-based clinical practice guideline. https://www.aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hip-fractures-elderly-clinical-practice-guideline-4-24-19.pdf. Published September 5, 2014. Accessed August 17, 2021.
 
3. Sheehan KJ, Sobolex B, Guy P, et al, Canadian collaborative study of hip fractures. In-hospital mortality after hip fracture by treatment setting. CMAJ 2016;188:1219–1225.
 
4. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005;331:1374.
 
5. de Morton NA, Harding KE, Taylor NF, et al. Validity of the de Morton mobility index (DEMMI) for measuring the mobility of patients with hip fractures during rehabilitation. Disabil Rehabil 2013;35:325–333.
 
6. Elliott J, Beringer T, Kee F, et al. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 2003;56:788–795.
 
7. Mullen JO, Mullen NL. Hip fracture mortality: a prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res 1992;280:214–222.
 
8. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 2005;87:1123–1126.
 
9. Moran CG, Wenn RT, Sikand M, et al. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005;87:483–489.
 
10. Rae HC, Harris IA, McEvoy L, et al. Delay to surgery and mortality after hip fracture. Aust N Z J Surg 2007;77:889–891.
 
11. Malik AT, Panni UY, Masri BA, et al. The impact of surgeon volume and hospital volume on postoperative mortality and morbidity after hip fractures: a systematic review. Int J Surg 2018;54(Pt B):316–327.
 
12. Vidan MT, Sanches E, Gracia Y, et al. Causes and effects of surgical delay in patients with hip fractures: a cohort study. Ann Intern Med 2011;155:226–233.
 
13. Muraki S, Yamamoto S, Ishibashi H, et al. Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 2006;24:100–104.
 
14. Abrahamsen B, van Staa T, Ariely R, et al. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 2009;20: 1633–1650.
 
15. Cree M, Soskolne C, Belseck E, et al. Mortality and institutionalization following hip fracture. J Am Geriatr Soc 2020;48:283–288.
 
16. Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and metaanalysis. CMAJ 2010;182:1609–1616.
 
17. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing for surgery for hip fracture and patient outcomes. JAMA 2004;291:1738–1743.
 
18. Forni S, Pieralli F, Sergi A, et al. Mortality after hip fracture in the elderly: the role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Arch Gerontol Geriatr 2016;66: 13–17.
 
19. Lee DL, Elfar JC. Timing of hip fracture surgery in the elderly. Geriatr Orthop Surg Rehabil 2014;5:138–140.