Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Alvi is an Adult Joint Reconstruction Orthopedic Surgeon, Barrington Orthopedic Specialists, Schaumburg, Illinois. Dr. Thompson is Assistant Professor, Department of Orthopaedic Surgery, and Associate Director, Center for Cerebral Palsy, David Geffen School of Medicine, The University of California, Los Angeles, Los Angeles, California. Dr. Krishnan is a General Surgery Resident, Lenox Hill Hospital/Northwell Health, New York, New York. Dr. Kwasny is Professor of Preventive Medicine, Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University, Chicago, Illinois. Dr. Beal is Associate Professor and Program Director; and Dr. Manning is Associate Professor and Vice Chairman Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Address correspondence to: Hasham M. Alvi, MD, Barrington Orthopedic Specialists, 929 W. Higgins Road, Schaumburg, IL 60195 (tel, 847-285-4200; email, Halvi@barrringtonortho.com).
Hasham M. Alvi, MD Rachel M. Thompson, MD Varun Krishnan, MDMary J. Kwasny, ScD Matthew D. Beal, MD David W. Manning, MD . Time-to-Surgery for Definitive Fixation of Hip Fractures: A Look at Outcomes Based Upon Delay. Am J Orthop.
September 7, 2018
References
DISCUSSION
Previous research has demonstrated an association between age,3,4,25 comorbidity burden,1,3,25 gender,3,4 and ASA class4,18,21 with outcomes following hip fractures and serves as the basis of our matched analysis statistical methodology in assessing the effect of time-to-surgery on the outcome following hip fracture surgery. Prior investigators have also established the positive correlation between increased preoperative comorbidity burden and delay in time-to-surgery.10,15 This finding was confirmed in our unadjusted comparison of 3 time-to-surgery groups. However, prior investigations have not established a clear association between time-to-surgical intervention and postoperative morbidity and mortality.1,15,16,18,20,38 This study utilized a nationally representative dataset known for its data integrity and from which 6036 patients with surgically treated hip fractures, matched for surgery type, age, gender, and ASA class (a surrogate for severity of medical infirmary), were studied using adjusted regression modeling to afford an isolated statistical assessment of the effect of time-to-surgery on outcomes following hip fracture surgery.
Despite a large sample size and rigorous statistical methodology, for many outcome measures, our results show no support for the early or late operative intervention following hip fracture. We found no difference in 30-day mortality, readmission rate, nor total complication rate between the 3 time-to-surgery cohorts. This result indicates that the care of elderly patients following hip fracture is inherently complicated and that perioperative complication risk is probably only modestly modifiable by best medical practices, including optimizing time from clinical presentation to surgery.
As expected, patients who experienced longer delays from presentation to surgery were on average, more comorbid and more likely to yield abnormal preoperative lab values. However, in the adjusted analysis, delay in time-to-surgery, presumably for medical management, was not found to be associated with improved outcomes. In the same adjusted analysis, we uniquely identified that in the patients whose surgeries were delayed for more than 48 hours, the time from surgery-to-discharge was significantly increased. As a result, these patients spent extra days in the hospital both preoperatively and postoperatively, but without any corollary improvement in the outcomes.
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