title: Delayed surgery in hip fracture patients. Can we afford it?
abstract: The aim is to analyze whether time to surgery (TtoS) in hip fracture patients is associated with longer than expected length of stay (LofS) and whether there is any particular group in which this is especially relevant. We developed an observational study in Madrid, Spain. From 771 patients admitted to the orthopedic ward, we selected 723 with surgical delay ≤7 days. Age was characterized as younger (<81), elderly (81-90), very elderly (>90). Modified Barthel Index was classified as very dependent (<41), moderately dependent (41-80), independent (>80).
  
  
  RESULTS
  Median (IQR) TtoS was 3 (1-4) days; LofS 12 (7-15). Mean age was 84.3 years, 78.4% were women. TtoS was associated with LofS, which increased by 1.80 days (95% CI, 1.50-2.10) per delayed day (p<0.001). After adjustment for age, sex, functional status, we found an increase of 1.75 days (1.46-2.04) per day (p<0.001). We did not find effect of age or sex. Functional status had a higher effect in moderately dependent patients 2.25 days (1.78-2.72) than in very dependent or independent patients, 1.33 (0.37-2.30) and 1.50 days (1.09-1.91) respectively (p 0.012). As conclusion we could affirm that increasing TtoS leads to longer than expected LofS in hip fracture patients, particularly moderately dependent patients. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Hospital Clinico San Carlos, Admission, Madrid, Spain.
authors.forename: Patricia
authors.identifier: http://orcid.org/0000-0002-4464-6087
authors.initials: P
authors.lastname: Alonso-Fernández
authors.affiliation: Hospital Clinico San Carlos, Geriatrics, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Romero
authors.affiliation: Hospital Clinico San Carlos, Geriatrics, Madrid, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Chung
authors.affiliation: Hospital Clinico San Carlos, Geriatrics, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: García-Salmones
authors.affiliation: Hospital Clinico San Carlos, Geriatrics, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cabezas
authors.affiliation: Hospital Clinico San Carlos, Geriatrics, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Mora
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D013030:Spain; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: aging; delayed surgery; dependence; hip fracture; length of stay