title: Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery.
abstract: BACKGROUND
  Hip fractures are associated with high morbidity. Pressure ulcer formation after hip surgery is often related to delayed patient mobilization. The objectives of this study were to determine whether time-to-surgery affects development of pressure ulcers postoperatively and, thus, length of hospital stay.
  
  
  METHODS
  We performed a retrospective analysis of consecutive hip fracture patients, aged 60 years and above, who underwent surgery between 1995 and 2001. The primary outcome was in-hospital development of pressure ulcers. The secondary outcome measure was the overall length of hospital stay. Analyses were adjusted for relevant confounders.
  
  
  RESULTS
  Of the 722 patients enrolled, 488 patients (68%) received surgery at 12 h after admission. Approximately 30% (n = 214) developed pressure ulcers during admission, whilst 19% of patients operated within 12 h of admission developed pressure ulcers. Time-to-surgery was an independent predictor of both development of pressure ulcers (OR = 1.7, 95% confidence interval [CI] = 1.2-2.6; p = 0.008) and length of hospital stay (11.3 vs 13.3 days in the early and the late surgery group, respectively, p = 0.050). Furthermore, development of pressure ulcers was associated with prolonged postoperative hospital stay (19.5 vs 11.1 days for patients with and without pressure ulcers, respectively, p = 0.001) INTERPRETATION: : In hip fracture patients, time-to-surgery was an independent predictor of both postoperative pressure ulcer development and prolonged hospital stay. These data suggest that the implementation of an early surgery protocol following admission for hip fractures may reduce both the postoperative complications and overall hospital stay.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands. l.rademakers@ctc.unimaas.nl.|Department of Cardiothoracic Surgery, Maastricht University Hospital, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. l.rademakers@ctc.unimaas.nl.
authors.forename: Leonard M F
authors.initials: LM
authors.lastname: Rademakers
authors.affiliation: Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands.
authors.forename: Tryfon
authors.initials: T
authors.lastname: Vainas
authors.affiliation: Department of Surgery, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Stefan W A M
authors.initials: SW
authors.lastname: van Zutphen
authors.affiliation: Department of Traumatology, Maastricht University Hospital, Maastricht, The Netherlands.
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
authors.affiliation: Department of Traumatology, Maastricht University Hospital, Maastricht, The Netherlands.
authors.forename: Sven H
authors.initials: SH
authors.lastname: van Helden
keywords: Femur; Fracture care; Fractures of the proximal; Hip fracture; Hip fractures; Orthopedic trauma; Osteosynthesis; Soft tissue injuries and infection