Acute medical conditions delay hip fracture surgery, predict poor outcome
MedWire News: Poor outcome following hip fracture repair is largely associated with acute conditions that cause surgery to be delayed rather than the duration of delay per se, Spanish researchers believe.
"Early surgery may be a better choice for patients with hip fracture and no acute medical conditions, but the optimal time for surgery in patients with acute medical conditions remains to be determined," the team reports in the Annals of Internal Medicine.
María Vidán and co-workers, from the Hospital General Universitario Gregorio Marañón in Madrid, examined the prevailing belief that early repair of hip fracture, preferably within 24 hours of injury, reduces the risk of mortality and complications in 2250 elderly patients admitted to the hip fracture unit at their hospital.
Median time to surgery was 72 hours. Surgery was performed at least 48 hours after fracture in about two-thirds of patients; this delay was attributed to an acute medical condition in 60.7% of patients and a shortage of operating rooms in 33.1%.
Overall, 4.4% of patients died in hospital and 45.9% developed complications but these rates rose to 13.7% and 74.2% among clinically unstable patients, respectively.
There was a significant association between increasing delay to surgery and risk for mortality and complications. However, after adjusting for age, dementia and other chronic conditions, and functional status, only delays longer than 120 hours significantly increased the risk for death and complications.
Furthermore, adjusting for acute medical conditions further reduced the impact of length of delay on the likelihood of death or complications, except for an increased risk for urinary tract infection (odds ratio=1.54).
Adjusting for age, dementia and functional status did not alter the relationship between length of delay and risk for a poor outcome.
Vidán and co-workers therefore conclude: "The reported association between late surgery and higher morbidity and mortality in patients with hip fracture is mostly explained by medical reasons for surgical delay, although some association between very delayed surgery and worse outcomes persists."
By Lynda Williams