TY - JOUR
T1 - Identification of preoperative factors and postoperative outcomes in relation to delays in surgery for hip fractures
AU - Fluck, Ben
AU - Yeong, Keefai
AU - Lisk, Radcliffe
AU - Robin, Jonathan
AU - Fluck, David
AU - Fry, Chris H
AU - Han, Thang S
PY - 2022/7/1
Y1 - 2022/7/1
N2 - We evaluated factors and outcomes associated with elapsed time to surgery (ETTS) in 1081 men and 2891 women (mean age=83.5±9.1years) undergoing hip fracture surgery (2009-2019). Mortality rates were 4.8, 6.3, 6.2 and 10.3% (2=19.0, P<0.001), and hospital length of stay (LOS) >19days were 31.9, 32.8, 33.8 and 43.2% (2=18.5, P<0.001) for ETTS<24hours, 24-36hours, 36-48hours and ≥48hours, respectively. There were no differences between ETTS categories for failure to mobilise within one day of surgery, pressure ulcers or discharge to nursing care. After adjustment for age, sex, American Society of Anesthesiologists score and years of data collection, compared to Sunday, the risk of ETTS≥36hours was highest on Friday: OR=3.50 (95%CI=2.43-5.03) and Saturday OR=4.70 (95%CI=3.26-6.76). Compared with ETTS<24hours, there were increases in the risk of death when ETTT≥48hours: OR=2.31 (95%CI=1.47-3.65), and LOS>19days: OR=1.34 (95%CI=1.02-1.75). The median (interquartile range) LOS for ETTS<24hours was 12.7days (8.0-23.0), 24-36hours was 13.5days (8.4-22.9), 36-48hours was 14.1days (8.9-23.3), and ≥48hours was 16.9 (10.8-27.0) (P<0.001). The 10-year period of collection did not change the conclusions. In conclusion, admissions towards the end of the week are associated with delayed ETTS for hip fractures, whilst delay in surgery, particularly beyond 48hours, is associated with increased risk of mortality and prolonged LOS.
AB - We evaluated factors and outcomes associated with elapsed time to surgery (ETTS) in 1081 men and 2891 women (mean age=83.5±9.1years) undergoing hip fracture surgery (2009-2019). Mortality rates were 4.8, 6.3, 6.2 and 10.3% (2=19.0, P<0.001), and hospital length of stay (LOS) >19days were 31.9, 32.8, 33.8 and 43.2% (2=18.5, P<0.001) for ETTS<24hours, 24-36hours, 36-48hours and ≥48hours, respectively. There were no differences between ETTS categories for failure to mobilise within one day of surgery, pressure ulcers or discharge to nursing care. After adjustment for age, sex, American Society of Anesthesiologists score and years of data collection, compared to Sunday, the risk of ETTS≥36hours was highest on Friday: OR=3.50 (95%CI=2.43-5.03) and Saturday OR=4.70 (95%CI=3.26-6.76). Compared with ETTS<24hours, there were increases in the risk of death when ETTT≥48hours: OR=2.31 (95%CI=1.47-3.65), and LOS>19days: OR=1.34 (95%CI=1.02-1.75). The median (interquartile range) LOS for ETTS<24hours was 12.7days (8.0-23.0), 24-36hours was 13.5days (8.4-22.9), 36-48hours was 14.1days (8.9-23.3), and ≥48hours was 16.9 (10.8-27.0) (P<0.001). The 10-year period of collection did not change the conclusions. In conclusion, admissions towards the end of the week are associated with delayed ETTS for hip fractures, whilst delay in surgery, particularly beyond 48hours, is associated with increased risk of mortality and prolonged LOS.
KW - mortality
KW - length of stay
KW - best practice tariff
KW - elapsed time to surgery
U2 - 10.7861/clinmed.2021-0590
DO - 10.7861/clinmed.2021-0590
M3 - Article (Academic Journal)
C2 - 35882497
SN - 1470-2118
SP - 313
EP - 319
JO - Clinical Medicine
JF - Clinical Medicine
ER -