Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture.
BACKGROUND
The purpose of this study was to investigate the reasons for delayed surgery in patients with proximal hip fracture and to compare differences in mortality between delayed surgery cases and non-delayed surgery cases. In addition, we evaluated causal factors for delayed surgery that affected differences in mortality.


METHODS
From 2003 to 2013, 1290 patients (1290 hips) with unilateral femoral neck or intertrochanteric fractures who underwent surgery were categorized into Group Ia (402 patients, early surgery group) and Group Ib (888 patients, delayed surgery group). The delayed surgery group was categorized as Group IIa (270 patients, pre-hospital delay group) and Group IIb (618 patients, post-hospital delay group). Among 618 patients with post-hospital delay, 165 patients in Group IIIa were defined as delayed surgery cases due to patient factors, and 453 patients in Group IIIB were defined as delayed surgery cases due to hospital factors. Early and late mortality was compared between each group.


RESULTS
Of 1290 patients, 888 patients underwent delayed surgery (mean 7.5 days, range 3-167 days) after hip fracture. The cumulative mortality rate at 30, 60 days, 3, and 12 months was 0.7, 2.0, 3.0, and 9.5% in Group Ia, respectively, and 2.4, 4.5, 5.2, and 14.5% in Group Ib, respectively (p = 0.047, p = 0.027, p = 0.078, and p = 0.012, respectively). Of 618 patients with post-hospital surgery delay, the cumulative mortality rate at 30 days and 12 months was 4.8 and 21.2% in Group IIIa, respectively, and 1.8, and 12.6% in Group IIIb, respectively (p = 0.033 and p = 0.008, respectively). After adjustments, patient factors for delayed surgery (HR 2.780; 95% CI 1.012-7.640, p = 0.047) were significantly associated with death after hip fracture.


CONCLUSIONS
This study demonstrated that delayed surgery was significantly related to 30-day and 1-year mortality. Surgery delay due to drugs' hold and medical comorbidity was related to 30-day mortality after adjustment.
Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
Yong-Han
YH
Cha
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. hayongch@naver.com.
Yong-Chan
YC
Ha
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Jun-Il
JI
Yoo
Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
Yeon-Seung
YS
Min
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Young-Kyun
YK
Lee
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Kyung-Hoi
KH
Koo
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
Hip fracture; Mortality; Risk factor; Surgery delay