title: Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems?
abstract: BACKGROUND
  Adverse outcomes for patients with isolated hip fracture have been documented when preoperative delay is longer than 48 hours. An efficient system will have the capacity to repair all hip fractures within 48 hours. We hypothesized that in an efficient system, there would be a medical justification for a delay greater than 48 hours. The purpose of this study was to identify the causes and outcome of delay for hip surgery in an efficient system.
  
  
  METHODS
  All patients with isolated hip fracture admitted to a regional trauma center from April 1993 to March 2003 were reviewed. Demographics, presence of comorbidity, preoperative delay, complications, and mortality were collected. Univariate and multivariate analysis were carried out.
  
  
  RESULTS
  The cohort included 977 patients. Overall mortality was 12.2%. Surgery was performed within 24 hours in 53% of cases and within 48 hours in 87% of cases. The presence of comorbidity partly explained longer (>48 hours) surgical delays. Multivariate analysis revealed that age greater than 65, male sex, and the presence of pulmonary and cardiac comorbid conditions or an active cancer but not surgical delay were associated with mortality and complications. However, surgical delay was associated with longer postsurgical hospital stay, independently of the presence of comorbidity or increasing age.
  
  
  CONCLUSIONS
  Preoperative delay does not entail adverse outcomes when the surgery is delayed to allow for treatment of comorbid medical conditions. Preoperative delay is associated with a longer hospital stay. The presence of comorbidity only partly explains preoperative delay and adverse outcomes. A prospective study coding for the severity of comorbid conditions and the justification of the preoperative delay will be required to fully elucidate the link between delay and outcome.
authors.affiliation: Department of Traumatology, Charles-LeMoyne Hospital, Greenfield Park, Canada. eric.bergeron@traumaquebec.org
authors.forename: Eric
authors.initials: E
authors.lastname: Bergeron
authors.forename: Andre
authors.initials: A
authors.lastname: Lavoie
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bamvita
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ratte
authors.forename: Charles
authors.initials: C
authors.lastname: Gravel
authors.forename: David
authors.initials: D
authors.lastname: Clas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers