The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures.
BACKGROUND
Whether reducing time-to-surgery for elderly patients suffering from hip fracture results in better outcomes remains subject to controversial debates.


METHODS
As part of a prospective observational study conducted between January 2002 and September 2003 on hip-fracture patients from 268 acute-care hospitals all over Germany, we investigated the relationship of time-to-surgery with frequency of post-operative complications and one-year mortality in elderly patients (age > or =65) with isolated proximal femoral fracture (femoral neck fracture or pertrochanteric femoral fracture). Patients with short (< or =12 h), medium (> 12 h to < or =36 h) and long (> 36 h) times-to-surgery, counting from the time of the fracture event, were compared for patient characteristics, operative procedures, post-operative complications and one-year mortality.


RESULTS
Hospital data were available for 2916 hip-fracture patients (mean age (SD) in years: 82.1 (7.4), median age: 82; 79.7% women). Comparison of groups with short (n = 802), medium (n = 1191) and long (n = 923) time-to-surgery revealed statistically significant differences in a few patient characteristics (age, American Society of Anesthesiologists ratings classification and type of admission) and in operative procedures (total hip endoprosthesis, hemi-endoprosthetic implants, other osteosynthetic procedures). However, comparison of these same groups for frequency of postoperative complications revealed only some non-significant associations with certain complications such as post-operative bleeding requiring treatment (early surgery patients) and urinary tract infections (delayed surgery patients). Both unadjusted rates of one-year all-cause mortality (between 18.1% and 20.5%), and the multivariate-adjusted hazard ratios (HR for time-to-surgery: 1.04; p = 0.55) showed no association between mortality and time-to-surgery.


CONCLUSIONS
Although this study found a trend toward more frequent post-operative complications in the longest time-to-surgery group, there was no effect of time-to-surgery on mortality. Shorter time-to-surgery may be associated with somewhat lower rates of post-operative complications such as decubitus ulcers, urinary tract infections, thromboses, pneumonia and cardiovascular events, and with somewhat higher rates of others such as post-operative bleeding or implant complications.
Smektala
Rüdiger
R
Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, D-44801 Bochum, Germany. ruediger.smektala@ruhr-uni-bochum.de
Endres
Heinz G
HG
Dasch
Burkhard
B
Maier
Christoph
C
Trampisch
Hans J
HJ
Bonnaire
Felix
F
Pientka
Ludger
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000601:surgery*; D005269:Femur / Q000293:injuries / Q000473:pathology / Q000601:surgery; D005592:Fracture Fixation / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality*; D019106:Postoperative Hemorrhage / Q000401:mortality; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome