The effect of early surgery after hip fracture on 1-year mortality.
BACKGROUND
Hip fracture injuries are identified as one of the most serious healthcare problems affecting older people. Many studies have explored the associations among patient characteristics, treatment processes, time to surgery and various outcomes in patients hospitalized for hip fracture. The objective of the present study is to evaluate the difference in 1-year mortality after hip fracture between patients undergoing early surgery (within 2 days) and patients undergoing delayed surgery in Italy.


METHODS
Observational, retrospective study based on the Hospital Information System (HIS). This cohort study included patients aged 65 years and older who were residing in Italy and were admitted to an acute care hospital for a hip fracture between 1 January 2007 and 31 December 2012. A multivariate Cox regression analysis was used to assess the effect of early surgery on the likelihood of 1-year mortality after hip fracture, adjusting for risk factors that could affect the outcome under study. The absolute number of deaths prevented by exposure to early surgery was calculated.


RESULTS
We studied a total of 405,037 admissions for hip fracture. Patients who underwent surgery within 2 days had lower 1-year mortality compared to those who waited for surgery more than 2 days (Hazard Ratios -HR-: 0.83; 95 % CI: 0.82-0.85). The number of deaths prevented by the exposure to early surgery was 5691.


CONCLUSIONS
This study is the first to evaluate the association between time to surgery and 1-year mortality for all Italian elderly patients hospitalized for hip fracture. The study confirmed the previous reports on the association between delayed surgery and increased mortality and complication rates in elderly patients admitted for hip fracture. Our data support the notion that deviating from surgical guidelines in hip fracture is costly, in terms of both human life and excess hospital stay.
Department of Epidemiology, Regional Health Service, Via Santa Costanza 53, 00198, Rome, Italy. p.colais@deplazio.it.
Paola
P
Colais
Department of Epidemiology, Regional Health Service, Via Santa Costanza 53, 00198, Rome, Italy. m.dimartino@deplazio.it.
Mirko
M
Di Martino
Department of Epidemiology, Regional Health Service, Via Santa Costanza 53, 00198, Rome, Italy. d.fusco@deplazio.it.
Danilo
D
Fusco
Senior Epidemiologist Consultant, Rome, Italy. carlo.a.perucci@gmail.com.
Carlo Alberto
CA
Perucci
National Outcome Program, Italian Agency for Health Services, Via Puglie 23, 00187, Rome, Italy. davoli@agenas.it.
Marina
M
Davoli
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data