A1 Refereed original research article in a scientific journal
Delay to Surgery of Less Than 12 Hours Is Associated With Improved Short- and Long-Term Survival in Moderate- to High-Risk Hip Fracture Patients
Authors: Hongisto MT, Nuotio MS, Luukkaala T, Väistö O, Pihiajamäki HK
Publisher: SAGE PUBLICATIONS INC
Publication year: 2019
Journal: Geriatric Orthopaedic Surgery and Rehabilitation
Journal name in source: GERIATRIC ORTHOPAEDIC SURGERY & REHABILITATION
Journal acronym: GERIATR ORTHOP SURG
Article number: UNSP 2151459319853142
Volume: 10
Number of pages: 7
ISSN: 2151-4585
eISSN: 2151-4593
DOI: https://doi.org/10.1177/2151459319853142
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/42713831
Introduction: The effect of delays before surgery of 24 hours, 48 hours, and 72 hours on short- and long-term survival has been investigated comprehensively in hip fracture patients, but with controversial results. However, there is only limited evidence for how a threshold of 12-hour delay before hip fracture surgery affects survival. Materials and Methods: A prospective observational study of 884 consecutive hip fracture patients (age >= 65 years) undergoing surgery was carried out in terms of 30- and 365-day survival. A Cox hazard regression survival model was constructed for 724 patients with American Society of Anesthesiologists score >= 3 with adjustments of age, gender, cognition, number of medications on admission, hip fracture type, and prior living arrangements. Results: Patients who underwent surgery within 12 hours had better chances of survival than did those with 12 to 24 hours (hazard ratio [HR]: 8.30; 95% confidence interval [CI]: 1.13-61.4), 24 to 48 hours (HR: 7.21; 95% CI: 0.98-52.9), and >48 hours (HR: 11.75; 95% CI: 1.53-90.2) delay before surgery. Long-term survival was more influenced by nonadjustable patient features, but the adverse effect of >48 hours delay before surgery was noticed with HR: 2.02; 95% CI: 1.08-3.80. Increased age and male gender were significantly associated with worse short- and long-term survival. Discussion/Conclusions: Early hip fracture surgery within 12 hours of admission is associated with improved 30-day survival among patients with ASA score >= 3. Delay to surgery of more than 48 hours has an adverse effect on 365-day survival, but factors related to patients' comorbidities have a great influence on long-term survival.
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