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01-08-2018 | Original Paper

Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing

Authors: Siu Him Janus Wong, Xinshuo Christian Fang, King Hang Dennis Yee, Tak Man Wong, Cheuk Ting Terence Pun, Tak Wing Lau, Ka Li Frankie Leung

Published in: International Orthopaedics | Issue 8/2018

Abstract

Purpose

The association between delayed hip fracture surgery and mortality remains elusive because of strong confounding by comorbidity factors. We designed a study to investigate the effect of small delays in surgery due to holidays.

Methods

Consecutive hip fractures operated in a high-income, publicly funded healthcare system between 2006 and 2013 were analysed. Age <65 years, pathological fractures, history of previous hip operation and time to surgery >seven days were excluded. Patients were grouped according to number of holidays following admission (HFA) as a surrogate for time to surgery, with difference in mean time to surgery tested for statistical significance and baseline characteristics including age, sex, Charlson comorbidity index (CCI) and fracture and operation types assessed. Survival up to two years was compared.

Results

Thirty-one thousand five hundred and ninety-two patients were included. Patient groups with zero, one, two or three HFA had significantly different mean time to operation of 2.25, 2.47, 2.67 and 2.84 days, respectively (Kruskal–Wallis test p < 0.0001), but baseline characteristics were similar. There was no difference in mortality at six months (p = 0.431) and two years (p = 0.785). Cox’s regression analysis identified age, gender and CCI as independent predictors of mortality but not HFA, and the adjusted hazards ratio for each HFA increment was 1.026 [95% confidence interval (CI) 0.999–1.025; p = 0.056] which was not statistically significant.

Conclusions

We observed no increase in mortality rate in patients having small delays in surgery because of holidays.

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Title: Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing
Authors: Siu Him Janus Wong
Xinshuo Christian Fang
King Hang Dennis Yee
Tak Man Wong
Cheuk Ting Terence Pun
Tak Wing Lau
Ka Li Frankie Leung
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3737-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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