Post-operative mortality related to waiting time for hip fracture surgery

Abstract

In this retrospective study, we looked at the difference in 1 year mortality between two groups of patients who were operated for fracture of the hip. Patients and methods: In cohort 1, 72% of the patients underwent surgery on the same day of admission, 15% of the patients were operated on the next day, the remaining 13% of the patients waited more than 1 day for surgery. The mean waiting time was 0.47 day. The percentage of patients who were operated on the same day of admission in cohort 2 was 18%. Sixty-nine percent of the patients had to wait 1 day before they were operated and 13% waited 2 days or more. The average waiting time was 1.01 days. The date of death for both the 166 patients in cohort 1 and the 197 patients in cohort 2, was obtained from the national mortality register and the 1 year mortality was calculated. These two groups of patients were from separate 12 month periods and the operations performed were either Dynamic Hip Screw (DHS) or hemiarthroplasty. The two groups were comparable in gender, age distribution and the types of operations. Results: There was an increase of 10.1% (P<0.025, χ², 1 d.f.; 95% CI 1.7–18.5) in the mortality of patients in cohort 2. The mortality data of the two cohorts was also analysed after dividing the patients into three groups according to their age. A statistically significant increase in mortality of 16.9% in patients over 80 years of age in cohort 2 was found. The difference in mortality was still statistically significant when only patients over 80 years of age and having a DHS operation were compared. Total mortality at 2 years after the operation was the same in the two cohorts. Mortality rate for patients in cohort 2 was less than that for cohort 1 patients during the second post-operative year. Conclusion: This study shows that survival at 1 year is better when patients who are medically fit for surgery are operated on the same day of admission. This survival advantage is more pronounced for patients who are over 80 years of age.

Introduction

Fractures of the hip, which most commonly occur in the elderly, are associated with a very high mortality. With increasing life expectancy these injuries are on the increase and will thus continue to be a substantial workload for trauma departments. The elderly are the most prone to such fractures because of their frequent falls (due to impaired balance and co-ordination) and the high prevalence of osteoporosis in this age group.7., 11. Operative treatment of such fractures is usually straight forward, but post-operative recovery and rehabilitation is fraught with complications.

One year mortality following hip fracture surgery is remarkably high, and is usually around 26%² but has been reported to range from 14 to 36%. It is highest during the first 6 months after injury, and after the first year it approaches that of patients with similar age and sex.5., 6. One factor which can possibly affect 1 year mortality is the waiting time for surgery. Various studies have addressed this issue with conflicting conclusions. The purpose of this study is to examine whether waiting time for surgery affects 1 year mortality.