Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2018 Sep 25

PMID 30245906

Citations 11

Authors

Andrew Bennett

Hsin Li

Aakash Patel

Kevin Kang

Piyush Gupta

Jack Choueka

Dennis E Feierman

Affiliations

Soon will be listed here.

Abstract

Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization.

Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system.

Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( = .0002) and 2.26 compared to the ASA 3 group ( = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity.

Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality.

Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.

Citing Articles

Factors associated with thirty-day mortality and intensive care unit admission in patients undergoing hip fracture surgery.

Tekir Yilmaz E, Sahin Y, Olgun Keles B, Altinbas A Ulus Travma Acil Cerrahi Derg. 2024; 30(8):571-578.

PMID: 39092971 PMC: 11372486. DOI: 10.14744/tjtes.2024.24186.

Is the Timing of Surgery a Sufficient Predictive Factor for Outcomes in Patients with Proximal Femur Fractures? A Systematic Review.

Radulescu M, Necula B, Mironescu S, Roman M, Schuh A, Necula R J Pers Med. 2024; 14(7).

PMID: 39064027 PMC: 11277622. DOI: 10.3390/jpm14070773.

Early surgery? In-house mortality after proximal femoral fractures does not increase for surgery up to 48 h after admission.

Fenwick A, Pfann M, Antonovska I, Mayr J, Lisitano L, Nuber S Aging Clin Exp Res. 2023; 35(6):1231-1239.

PMID: 37138145 PMC: 10156577. DOI: 10.1007/s40520-023-02406-x.

Operative Management of Hip Fractures Within 24 Hours in the Elderly is Achievable and Associated With Reduced Opiate Use.

Allahabadi S, Roostan M, Roddy E, Ward D, Rogers S, Kim C Geriatr Orthop Surg Rehabil. 2023; 13:21514593221116331.

PMID: 37101932 PMC: 10123378. DOI: 10.1177/21514593221116331.

Increasing Quality and Frequency of Goals-of-Care Documentation in the Highest-Risk Surgical Candidates: One-Year Results of the Surgical Pause Program.

Oyekan A, Lee J, Hodges J, Chen S, Wilson A, Fourman M JB JS Open Access. 2023; 8(2).

PMID: 37101601 PMC: 10125643. DOI: 10.2106/JBJS.OA.22.00107.

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