title: Early surgery for patients with a fracture of the hip decreases 30-day mortality.
abstract: There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days. Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality.
authors.affiliation: Orthopaedic Department, Lister Hospital, Stevenage, SG1 4AB, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Bretherton
authors.affiliation: Peterborough City Hospital, Department Box 211, Peterborough and Stamford Hospitals NHS Foundation Trust, Bretton Gate, Peterborough, PE3 9GZ, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Parker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D016001:Confidence Intervals; D016208:Databases, Factual; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000401:mortality*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: 12 hours; 30-day mortality; ASA grade; Early surgery; Hip fracture