In the Journals

Increased wait time linked with greater 30-day mortality risk after hip fracture surgery

Results from this study indicated an increased wait time correlated with a greater chance of mortality within 30 days of surgery for hip fracture.

Daniel Pincus

“What is interesting is that we found a linear relationship between risk and delay, but only after 24 hours,” study author Daniel Pincus, MD, told Healio.com/Orthopedics. “Before 24 hours, there was no increased risk of waiting. Surgery within 24 hours thus appears to be a ‘safe window.’ Some patients will benefit from preoperative medical treatment, so rushing them to the OR before this happens is probably not the right answer. If patients are healthy and ready for the OR, however, there is no reason they need to wait until 24 hours, especially as they are suffering in pain.”

He added, “Unfortunately, only one-third of patients in the study received care within 24 hours. Therefore, though there have been improvements made in the last 5 or 10 years in getting patients to the operating room faster, more work needs to be done.”

Pincus and colleagues performed a population-based, retrospective study of 42,230 patients who underwent hip fracture surgery at 72 hospitals in Ontario, Canada between April 1, 2009 and March 31, 2014. The mean age of patients was 80.1 years. The probability of each complication according to wait time was modeled with risk-adjusted restricted cubic splines. The primary outcome was 30-day mortality. Other outcomes evaluated included a composite of mortality and medical complications, such as myocardial infarction, deep vein thrombosis, pulmonary embolism and pneumonia. Percent absolute risk differences were used to compare outcomes between early and delayed groups.

At 30 days, the overall mortality rate was 7%. Investigators noted that when the wait times were longer than 24 hours, the complication risk increased, regardless of the complication that ensured. The 13,371 patients who underwent surgery after 24 hours had a significantly greater risk of mortality and composite outcome after 30 days compared with the 13,731 propensity score-matched patients who underwent surgery early. – by Monica Jaramillo

 

Disclosures: The study was supported by the Marvin Tile chair in orthopedic surgery at Sunnybrook Health Sciences Centre in Toronto and by the Institute for Clinical Evaluative Sciences.

Results from this study indicated an increased wait time correlated with a greater chance of mortality within 30 days of surgery for hip fracture.

Daniel Pincus

“What is interesting is that we found a linear relationship between risk and delay, but only after 24 hours,” study author Daniel Pincus, MD, told Healio.com/Orthopedics. “Before 24 hours, there was no increased risk of waiting. Surgery within 24 hours thus appears to be a ‘safe window.’ Some patients will benefit from preoperative medical treatment, so rushing them to the OR before this happens is probably not the right answer. If patients are healthy and ready for the OR, however, there is no reason they need to wait until 24 hours, especially as they are suffering in pain.”

He added, “Unfortunately, only one-third of patients in the study received care within 24 hours. Therefore, though there have been improvements made in the last 5 or 10 years in getting patients to the operating room faster, more work needs to be done.”

Pincus and colleagues performed a population-based, retrospective study of 42,230 patients who underwent hip fracture surgery at 72 hospitals in Ontario, Canada between April 1, 2009 and March 31, 2014. The mean age of patients was 80.1 years. The probability of each complication according to wait time was modeled with risk-adjusted restricted cubic splines. The primary outcome was 30-day mortality. Other outcomes evaluated included a composite of mortality and medical complications, such as myocardial infarction, deep vein thrombosis, pulmonary embolism and pneumonia. Percent absolute risk differences were used to compare outcomes between early and delayed groups.

At 30 days, the overall mortality rate was 7%. Investigators noted that when the wait times were longer than 24 hours, the complication risk increased, regardless of the complication that ensured. The 13,371 patients who underwent surgery after 24 hours had a significantly greater risk of mortality and composite outcome after 30 days compared with the 13,731 propensity score-matched patients who underwent surgery early. – by Monica Jaramillo

 

Disclosures: The study was supported by the Marvin Tile chair in orthopedic surgery at Sunnybrook Health Sciences Centre in Toronto and by the Institute for Clinical Evaluative Sciences.

    Perspective

    J. Tracy Watson

    Many investigators have affirmed that an increased time to surgery for hip fractures increases the likelihood of complications including urinary tract infections, cardiovascular issues, pneumonia, postoperative dementia, thrombosis, pulmonary embolism and length of stay.

    The big question of whether delays to surgery are related to an increased mortality is disparate, with no definitive conclusions. Most of these studies are vastly underpowered and thus, no firm conclusions can be made. However, this study by Pincus and colleagues reviewed a large cohort of more than 42,230 adults. Although the study is retrospective, they found wait times longer than 24 hours were associated with a higher risk-adjusted likelihood of 30-day mortality.

    This study should give surgeons additional hard data to demonstrate the value of strategies aimed at preventing time to surgery past 24 to 36 hours. This would include the development of specific preoperative pathways with dedicated personnel to help expedite the preoperative process. As well, in centers with a large volume of these cases, expanded OR availability for these cases can now be justified with the hiring of an additional OR team to be available beyond normal hours. 

    • J. Tracy Watson, MD
    • Orthopedics Today Editorial Board Member

    Disclosures: Watson reports no relevant financial disclosures.