Hip fracture surgery delay increases risk for adverse outcomes
MedWire News: Delaying hip fracture surgery increases the risk for mortality and disability in the first 6 months after injury, say researchers who also found that osteoporosis treatment can improve outcomes.
Stefania Maggi (Institute of Neuroscience, Padova, Italy) and co-workers highlight the risks associated with surgery 48 hours or more after hip fracture, noting that 60% of the patients surveyed at nine Italian hospitals experienced a delay of at least this length.
The team prospectively examined the relationship between delayed hip fracture surgery and adverse outcomes in 3288 patients aged 50 years and older with fragility fractures who were followed-up for 6 months after discharge. The patients underwent surgery an average of 3.8 days after fracture and stayed in hospital for an average of 14.5 days.
In all, 61% of patients were followed-up for 6 months, with 815 cases lost to follow-up, while 102 patients died before discharge and 361 patients died in the first 6 months after discharge. Nearly one-third (32%) received osteoporosis treatment at discharge.
Analysis showed that death was predicted significantly by increasing age, comorbidity, functional disability before fracture, and receipt of surgery more than 48 hours after fracture.
Patients with higher levels of functional ability at 6-month follow-up were significantly more likely to have received surgery within 24 hours of fracture and osteoporosis treatment on discharge.
Patients were most likely to have a walking disability after 6 months if they were older, had comorbid diseases, were disabled before hip fracture, and if they received surgery more than 24 hours after fracture.
Noting the significant impact of osteoporosis treatment on function, the team says clinical risk-assessment did not differ between treated and untreated patients, indicating no selection bias.
“We know that the risk of subsequent fractures is particularly high in the 6 months after a first fracture and that some antiresorptive treatments are very effective in reducing the risk in this time frame, so we can suggest a true protection derived from the therapy,” Maggi et al comment in the journal Osteoporosis International.
Observing that hip fracture surgery delay is mostly caused by administrative rather than clinical factors, they conclude: “Considering that such delays are responsible for increased mortality and walking disability, avoidable administrative and organizational problems need to be carefully considered.”
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By Lynda Williams