Identification of preoperative factors and postoperative outcomes in relation to delays in surgery for hip fractures

Ben Fluck, Keefai Yeong, Radcliffe Lisk, Jonathan Robin, David Fluck, Chris H Fry, Thang S Han*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
19 Downloads (Pure)

Abstract

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.
Original languageEnglish
Pages (from-to)313-9
JournalClinical Medicine
DOIs
Publication statusPublished - 1 Jul 2022

Keywords

  • mortality
  • length of stay
  • best practice tariff
  • elapsed time to surgery

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