A Comparison of Complication Rates Between Early and Delayed Surgery Among Filipino Patients with Fragility Fractures of the Hip

Objectives: Existing standards of care recommend operative management for fragility fractures of the hip. Early intervention has been associated with lower incidence of morbidity and mortality. A lack of consensus remains in the Philippines however, regarding timing of surgery. We sought to determine the effects of surgical timing on in-hospital complications among Filipino patients with fragility hip fractures.

Methods: All patients admitted for fragility hip fractures in a single tertiary-care facility from 2014-2016 were analyzed retrospectively. Subjects treated within 72 hours were grouped under "early intervention," while those managed beyond were designated "delayed intervention." Primary outcomes were complications during admission, while secondary outcome was length of hospital stay. A total of 96 patients met our inclusion criteria, of which 41 (42.71%) underwent early intervention. Baseline characteristics for both groups were comparable.

Results: A significantly lower incidence of pressure ulcers (2.4% for ≤72hours vs 45.5%; =<0.0001), pneumonia (7.32% vs 47.27%; =<0.0001), and urinary tract infection (4.88% vs 40%; =<0.0001), as well as shorter hospital stay (mean: 8.85 days±5.4 vs 14.6 days±13.3; =0.01) were seen in the early intervention group. More cases of documented deep vein thrombosis were recorded in the delayed intervention group (83.3% versus 16.6%), as was the only case of in-hospital mortality.

Conclusion: Early intervention showed a significantly lower incidence of in-hospital complications among patients with fragility fractures of the hip, suggesting that surgery within 72 hours may lead to better outcomes by helping to reduce the incidence of pressure sores, pneumonia, and urinary tract infection among Filipinos with hip fractures, while reducing length of admission.