The Consequences of Out-of-hours Hip Fracture Surgery: Insights from a Retrospective Nationwide Study

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2021 Oct 8

PMID 34622327

Citations 4

Authors

Maximilian Peter Forssten

Ahmad Mohammad Ismail

Tomas Borg

Yang Cao

Per Wretenberg

Gary Alan Bass

Shahin Mohseni

Affiliations

Soon will be listed here.

Abstract

Purpose: The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day.

Methods: All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00-17:00) and out-of-hours surgery (17:00-08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality.

Results: Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00-1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01-1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04-1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01-1.15), p = 0.022] compared to on-hour surgery.

Conclusion: Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.

Citing Articles

Proximal Femur Fractures: Evaluating the Necessity of On-Call Surgery.

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Delay to surgery beyond 12 hours is associated with increased hip fracture mortality.

Warren M, Bretherton C, Parker M Eur J Orthop Surg Traumatol. 2024; 34(6):2973-2980.

PMID: 38844565 PMC: 11377486. DOI: 10.1007/s00590-024-03997-5.

Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study.

Mohammad Ismail A, Forssten M, Bass G, Trivedi D, Ekestubbe L, Ioannidis I Trauma Surg Acute Care Open. 2022; 7(1):e000957.

PMID: 36148316 PMC: 9486374. DOI: 10.1136/tsaco-2022-000957.

Focus on geriatric proximal femur fractures: factors that influence the outcome.

Kobbe P, Pishnamaz M, Hildebrand F Eur J Trauma Emerg Surg. 2022; 48(2):699-700.

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Dementia is a surrogate for frailty in hip fracture mortality prediction.

Forssten M, Ioannidis I, Mohammad Ismail A, Bass G, Borg T, Cao Y Eur J Trauma Emerg Surg. 2022; 48(5):4157-4167.

PMID: 35355091 PMC: 9532301. DOI: 10.1007/s00068-022-01960-9.

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