A multicenter survey on profile of care for hip fracture: predictors of mortality and disability.
Because delay in time to surgery beyond 24-48 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization.


BACKGROUND
Delays in surgery for hip fracture have been reported to be associated with negative outcomes. However, most studies are based on retrospective analysis of hospital discharge data, which cannot determine functional status or general health status of patients prior to the fracture.


METHODS
Using a prospective cohort design, data were collected on 3,707 patients aged >50 years during hospitalization for hip fracture and in a 6-month postdischarge follow-up. Baseline information included age, gender, living arrangement, prefracture walking ability, walking aid, ASA grade, type and reason of fracture, time to surgery, type of surgery, date and destination at discharge, and osteoporosis treatment. Follow-up data included living arrangement, walking ability, and mortality.


RESULTS
Six-month mortality was positively associated with increasing age, comorbidity, prefracture functional disability, and having surgery more than 48 h after admission. Higher levels of functional status at 6 months were independently associated with surgery occurring within 24 h of the fracture and with osteoporosis therapy at discharge. Walking disability was associated with older age, comorbidity, disability before fracture, and time to surgery after 24 h.


CONCLUSIONS
Delay in surgery is a major cause of mortality and disability at 6 months, and interventions to modify this pattern of care are urgently needed.
Maggi
S
S
Leonardo Foundation (Abano Terme), Section on Aging, Padova, Institute of Neuroscience, CNR, Via Giustiniani 2, 35128 Padua, Italy. stefania.maggi@in.cnr.it
Siviero
P
P
Wetle
T
T
Besdine
R W
RW
Saugo
M
M
Crepaldi
G
G
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004185:Disability Evaluation; D004812:Epidemiologic Methods; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D011379:Prognosis; D013997:Time Factors; D016138:Walking