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Published in: Osteoporosis International 5/2009

01-05-2009 | Original Article

Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Authors: E. I. O. Vidal, D. C. Moreira-Filho, C. M. Coeli, K. R. Camargo Jr., F. B. Fukushima, R. Blais

Published in: Osteoporosis International | Issue 5/2009

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Abstract

Summary

This study aims to analyze whether the interval from hospital admission to surgery may be used as a surrogate of the actual gap from fracture to surgery when investigating in-hospital hip fracture mortality. After analyzing 3,754 hip fracture admissions, we concluded that those intervals might be used interchangeably without misinterpretation bias.

Introduction

The debate regarding the influence of time to surgery in hip fracture (HF) mortality is one of the most controversial issues in the HF medical literature. Most previous investigations actually analyzed the time from hospital admission to surgery as a surrogate of the less easily available gap from fracture to surgery. Notwithstanding, the assumption of equivalency between those intervals remains untested.

Methods

We analyzed 3,754 hospital admissions of elderly patients due to HF in Quebec, Canada. We compared the performance as predictors of in-hospital mortality of the delay from admission to surgery and the actual gap from fracture to surgery using univariate and multiple logistic regression analysis.

Results

The mean times from fracture to surgery and from admission to surgery were 1.84 and 1.02 days (P < 0.001), respectively. On univariate logistic regression, both times were slightly significant as mortality predictors, yielding similar odds ratios of 1.08 (P < 0.001) for time from fracture to surgery and 1.11 (P < 0.001) for time from admission to surgery. After accounting for other covariates, neither times remained significant mortality predictors.

Conclusion

The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.
Literature
1.
go back to reference Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL (2002) The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 112:702–709PubMedCrossRef Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL (2002) The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 112:702–709PubMedCrossRef
2.
go back to reference Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX (2006) Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care 44:552–559PubMedCrossRef Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX (2006) Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care 44:552–559PubMedCrossRef
3.
go back to reference McGuire K, Bernstein J, Polsky D, Silber J (2004) Delays until surgery after hip fracture increases mortality. Clin Orthop Rel Res 428:294–301CrossRef McGuire K, Bernstein J, Polsky D, Silber J (2004) Delays until surgery after hip fracture increases mortality. Clin Orthop Rel Res 428:294–301CrossRef
4.
go back to reference Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77:889–891PubMedCrossRef Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77:889–891PubMedCrossRef
5.
go back to reference Novack V, Jotkowitz A, Etzion O, Porath A (2007) Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 19:170–176PubMedCrossRef Novack V, Jotkowitz A, Etzion O, Porath A (2007) Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 19:170–176PubMedCrossRef
6.
go back to reference Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951PubMedCrossRef Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951PubMedCrossRef
7.
go back to reference Doruk H, Mas MR, Yildiz C, Sonmez A, Kyrdemir V (2004) The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 39:179–185PubMedCrossRef Doruk H, Mas MR, Yildiz C, Sonmez A, Kyrdemir V (2004) The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 39:179–185PubMedCrossRef
8.
go back to reference Gdalevich M, Cohen D, Yosef D, Tauber C (2004) Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124:334–340PubMedCrossRef Gdalevich M, Cohen D, Yosef D, Tauber C (2004) Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124:334–340PubMedCrossRef
9.
go back to reference Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489PubMedCrossRef Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489PubMedCrossRef
10.
go back to reference Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 87:361–366PubMed Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 87:361–366PubMed
11.
go back to reference Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 77:1551–1556PubMed Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 77:1551–1556PubMed
12.
go back to reference Casaletto JA, Gatt R (2004) Post-operative mortality related to waiting time for hip fracture surgery. Injury 35:114–120PubMedCrossRef Casaletto JA, Gatt R (2004) Post-operative mortality related to waiting time for hip fracture surgery. Injury 35:114–120PubMedCrossRef
13.
go back to reference Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 293:1203–1204CrossRef Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 293:1203–1204CrossRef
14.
go back to reference Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340PubMedCrossRef Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340PubMedCrossRef
15.
go back to reference Hefley FG Jr., Nelson CL, Puskarich-May CL (1996) Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am 78:581–583PubMed Hefley FG Jr., Nelson CL, Puskarich-May CL (1996) Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am 78:581–583PubMed
16.
go back to reference Dolk T (1990) Operation in hip fracture patients—analysis of the time factor. Injury 21:369–372PubMedCrossRef Dolk T (1990) Operation in hip fracture patients—analysis of the time factor. Injury 21:369–372PubMedCrossRef
17.
go back to reference D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429–1433PubMedCrossRef D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429–1433PubMedCrossRef
18.
go back to reference Levy AR, Tamblyn RM, Fitchett D, McLeod PJ, Hanley JA (1999) Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction. Can J Cardiol 15:1277–1282PubMed Levy AR, Tamblyn RM, Fitchett D, McLeod PJ, Hanley JA (1999) Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction. Can J Cardiol 15:1277–1282PubMed
19.
go back to reference R Development Core Team (2008) R: A Language and Environment for Statistical Computing. In. R Foundation for Statistical Computing, Vienna, Austria. Available at: http://www.R-project.org R Development Core Team (2008) R: A Language and Environment for Statistical Computing. In. R Foundation for Statistical Computing, Vienna, Austria. Available at: http://​www.​R-project.​org
21.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
22.
go back to reference Kenzora JE, McCarthy RE, Lowell JD, Sledge CB (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56PubMed Kenzora JE, McCarthy RE, Lowell JD, Sledge CB (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56PubMed
23.
go back to reference Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23:83–86PubMedCrossRef Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23:83–86PubMedCrossRef
24.
go back to reference Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MT, Thadaka R (1987) Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 59:1080–1088PubMedCrossRef Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MT, Thadaka R (1987) Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 59:1080–1088PubMedCrossRef
25.
go back to reference Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795PubMedCrossRef Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795PubMedCrossRef
26.
go back to reference Ho V, Hamilton BH, Roos LL (2000) Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 34:1499–1518PubMed Ho V, Hamilton BH, Roos LL (2000) Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 34:1499–1518PubMed
27.
go back to reference Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture: an autopsy study. Injury 26:237–240PubMedCrossRef Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture: an autopsy study. Injury 26:237–240PubMedCrossRef
28.
go back to reference Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N (1995) Differences in mortality after fracture of hip: the east Anglian audit. Bmj 310:904–908PubMed Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N (1995) Differences in mortality after fracture of hip: the east Anglian audit. Bmj 310:904–908PubMed
29.
go back to reference White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am 69:1335–1340PubMed White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am 69:1335–1340PubMed
30.
go back to reference Harty JA, McKenna P, Moloney D, D’Souza L, Masterson E (2007) Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg (Hong Kong) 15:270–272 Harty JA, McKenna P, Moloney D, D’Souza L, Masterson E (2007) Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg (Hong Kong) 15:270–272
31.
go back to reference Rogers FB, Shackford SR, Keller MS (1995) Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma 39:261–265PubMedCrossRef Rogers FB, Shackford SR, Keller MS (1995) Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma 39:261–265PubMedCrossRef
32.
go back to reference Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE (1997) Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop 26:621–627PubMed Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE (1997) Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop 26:621–627PubMed
33.
go back to reference Davis TR, Sher JL, Porter BB, Checketts RG (1988) The timing of surgery for intertrochanteric femoral fractures. Injury 19:244–246PubMedCrossRef Davis TR, Sher JL, Porter BB, Checketts RG (1988) The timing of surgery for intertrochanteric femoral fractures. Injury 19:244–246PubMedCrossRef
34.
go back to reference Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20:985–991PubMedCrossRef Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20:985–991PubMedCrossRef
35.
go back to reference Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K (1997) What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 157:513–520PubMedCrossRef Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K (1997) What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 157:513–520PubMedCrossRef
36.
go back to reference Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. Jama 291:1738–1743PubMedCrossRef Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. Jama 291:1738–1743PubMedCrossRef
37.
go back to reference Stoddart J, Horne G, Devane P (2002) Influence of preoperative medical status and delay to surgery on death following a hip fracture. ANZ J Surg 72:405–407PubMedCrossRef Stoddart J, Horne G, Devane P (2002) Influence of preoperative medical status and delay to surgery on death following a hip fracture. ANZ J Surg 72:405–407PubMedCrossRef
38.
go back to reference Parker MJ, Pryor GA (1992) The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 74:203–205PubMed Parker MJ, Pryor GA (1992) The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 74:203–205PubMed
39.
go back to reference Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14:371–377PubMedCrossRef Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14:371–377PubMedCrossRef
40.
go back to reference Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression: [Le delai operatoire est-il associe a une mortalite accrue chez les patients atteints d’une fracture de la hanche ? Synthese systematique, meta-analyse et meta-regression]. Can J Anaesth 55:146–154PubMed Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression: [Le delai operatoire est-il associe a une mortalite accrue chez les patients atteints d’une fracture de la hanche ? Synthese systematique, meta-analyse et meta-regression]. Can J Anaesth 55:146–154PubMed
41.
go back to reference Bryson GL (2008) Waiting for hip fracture repair—Do outcomes and patients suffer?/En attendant une chirurgie pour fracture de la hanche: est-ce que les patients et leur evolution en patissent? Can J Anaesth 55:135–139PubMed Bryson GL (2008) Waiting for hip fracture repair—Do outcomes and patients suffer?/En attendant une chirurgie pour fracture de la hanche: est-ce que les patients et leur evolution en patissent? Can J Anaesth 55:135–139PubMed
42.
go back to reference Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278PubMedCrossRef Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278PubMedCrossRef
43.
go back to reference Bhandari M, Tornetta P 3rd, Ellis T, Audige L, Sprague S, Kuo JC, Swiontkowski MF (2004) Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Arch Orthop Trauma Surg 124:10–16PubMedCrossRef Bhandari M, Tornetta P 3rd, Ellis T, Audige L, Sprague S, Kuo JC, Swiontkowski MF (2004) Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Arch Orthop Trauma Surg 124:10–16PubMedCrossRef
44.
go back to reference Vidal EI, Coeli CM, Pinheiro RS, Camargo KR Jr. (2006) Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil. Osteoporos Int 17:1569–1576PubMedCrossRef Vidal EI, Coeli CM, Pinheiro RS, Camargo KR Jr. (2006) Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil. Osteoporos Int 17:1569–1576PubMedCrossRef
Metadata
Title
Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?
Authors
E. I. O. Vidal
D. C. Moreira-Filho
C. M. Coeli
K. R. Camargo Jr.
F. B. Fukushima
R. Blais
Publication date
01-05-2009
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 5/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-008-0757-1

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