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Osteoporosis International
Published in: Osteoporosis International 2/2010

01-02-2010 | Original Article

A multicenter survey on profile of care for hip fracture: predictors of mortality and disability

Authors: S. Maggi, P. Siviero, T. Wetle, R. W. Besdine, M. Saugo, G. Crepaldi, For the Hip Fracture Study Group

Published in: Osteoporosis International | Issue 2/2010

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Abstract

Summary

Because delay in time to surgery beyond 24–48 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization.

Introduction

Delays in surgery for hip fracture have been reported to be associated with negative outcomes. However, most studies are based on retrospective analysis of hospital discharge data, which cannot determine functional status or general health status of patients prior to the fracture.

Methods

Using a prospective cohort design, data were collected on 3,707 patients aged >50 years during hospitalization for hip fracture and in a 6-month postdischarge follow-up. Baseline information included age, gender, living arrangement, prefracture walking ability, walking aid, ASA grade, type and reason of fracture, time to surgery, type of surgery, date and destination at discharge, and osteoporosis treatment. Follow-up data included living arrangement, walking ability, and mortality.

Results

Six-month mortality was positively associated with increasing age, comorbidity, prefracture functional disability, and having surgery more than 48 h after admission. Higher levels of functional status at 6 months were independently associated with surgery occurring within 24 h of the fracture and with osteoporosis therapy at discharge. Walking disability was associated with older age, comorbidity, disability before fracture, and time to surgery after 24 h.

Conclusions

Delay in surgery is a major cause of mortality and disability at 6 months, and interventions to modify this pattern of care are urgently needed.
Literature
1.
2.
Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208PubMed
3.
Hannan EL, Magaziner J, Wang JJ et al (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285:2736–2742CrossRefPubMed
4.
Fisher ES, Baron JA, Malenka DJ et al (1991) Hip fracture incidence and mortality in New England. Epidemiology 2:116–122CrossRefPubMed
5.
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg 77(10):1551–1556PubMed
6.
Pioli G, Barone A, Giusti A et al (2006) Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 18(5):381–387PubMed
7.
Magaziner J, Hawkes W, Hebel JR et al (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507PubMed
8.
Marottoli RA, Berkman LF, Cooney LM Jr (1992) Decline in physical function following hip fracture. J Am Geriatr Soc 40:861–866PubMed
9.
Jette AM, Harris BA, Cleary PD, Campion EW (1987) Functional recovery after hip fracture. Arch Phys Med Rehabil 68:735–740PubMed
10.
Royal College of Physicians (1989) Fractured neck of femur: prevention and management. Summary and recommendations of a report. J R Coll Physicians Lond 23:8–12
11.
Scottish Intercollegiate Guidelines Network (SIGN) (2002) Prevention and management of hip fracture in older people. SIGN Publication No. 56. ISBN 1899893 72 5
12.
Chilov MN, Cameron ID, March LM (2003) Evidence-based guidelines for fixing broken hips: an update. Med J Aust 179(9):489–493PubMed
13.
Davis FM, Woolner T, Frampton C et al (1987) Prospective multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 59:1080–1088CrossRefPubMed
14.
Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. BMJ 293:1203–1204CrossRefPubMed
15.
Hoerer D, Volpin G, Stein H (1993) Results of early and delayed surgical fixation of hip fractures in the elderly: a comparative, retrospective study. Bull Hosp Jt Dis 53:29–33PubMed
16.
Bredahl C, Nyholm B, Hindsholm KB et al (1992) Mortality after hip fracture: results of operation within 12 hours of admission. Injury 23:83–86CrossRefPubMed
17.
Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. Br Med J 332:947–951CrossRef
18.
Casaletto JA, Gatt R (2004) Post-operative mortality related to waiting time for hip fracture surgery. Injury 35(2):114–120CrossRefPubMed
19.
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(5):334–340CrossRefPubMed
20.
McGuire KJ, Bernstein J, Polsky D, Silber JH (2004) Delays until surgery after hip fracture increases mortality. Clin Orthop 428:294–301CrossRefPubMed
21.
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(3):170–176CrossRefPubMed
22.
Al-Ani AN, Samuelsson B, Tidermark J et al (2008) Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am 90(7):1436–1442CrossRefPubMed
23.
Dolk T (1990) Operation in hip fracture patients—analysis of the time factor. Injury 21:369–372CrossRefPubMed
24.
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
25.
Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture—an autopsy study. Injury 26:237–240CrossRefPubMed
26.
Hartgrink HH, Wille J, Konig P et al (1998) Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial. Clin Nutr 17:287–292CrossRefPubMed
27.
Parker MJ, Pryor GA (1992) The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 74:203–205PubMed
28.
Grimes JP, Gregory PM, Noveck H et al (2002) The effects of time to surgery on mortality and morbidity in patients following hip fracture. Am J Med 112(9):702–709CrossRefPubMed
29.
Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg 87(3):483–489CrossRefPubMed
30.
Orosz GM, Magaziner J, Hannan EL et al (2004) Association of timing of surgery for hip fracture and patient outcomes. J Am Med Assoc 291:1738–1743CrossRef
31.
Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77(10):889–891CrossRefPubMed
32.
Hommel A, Ulander K, Bjorkelund KB et al (2008) Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury 39(10):1164–1174CrossRefPubMed
33.
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. Can J Anaesth 55(3):146–154CrossRefPubMed
34.
Buck N, Devlin HB, Lunn JN (1987) The report of a confidential enquiry into perioperative deaths. Nuffield Provincial Hospitals Trust, London
35.
Campling EA, Devlin HB, Hoile RW, Lunn JN (1993) The Report of the National Confidential Enquiry into Perioperative Deaths 1991/2. NCEPOD, London
36.
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 39:261–265CrossRefPubMed
37.
Orosz GM, Hannan EL, Magaziner J et al (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1343CrossRefPubMed
38.
Foss NB, Kehlet H (2006) Short-term mortality in hip fracture patients admitted during weekends and holidays. Br J Anaesth 96(4):450–454CrossRefPubMed
39.
Maggi S, Noale M, Giannini S et al (2006) Quantitative heel ultrasound in a population-based study in Italy and its relationship with fracture history: the ESOPO study. Osteoporos Int 17(2):237–244CrossRefPubMed
40.
Iolascon G, Gimigliano F, Piscitelli P, Guida G (2007) Hip fracture in Italy: analysis of DRG data. Aging Clin Exp Res 19(3 Suppl):2–4PubMed
41.
Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284CrossRef
42.
Parker MJ, Currie CT, Mountain JA, Thorngren KG (1998) Standardisation audit of hip fracture in Europe (SAHFE). Hip Int 8:10–15
43.
Reginster J, Minne HW, Sorensen OH et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11(1):83–91CrossRefPubMed
44.
Elliott J, Beringer T, Kee F, AL ET (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56(8):788–795CrossRefPubMed
45.
Häkkinen A, Heinonen M, Kautiainen H et al (2007) Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up. Aging Clin Exp Res 19(2):139–144PubMed
46.
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331(7529):1374CrossRefPubMed
47.
Shoham Y, Peled R, Atar D et al (2005) Emergency room consultation policy prevents surgery delay in elderly patients with hip fractures. Harefuah 144(10):700–702 751PubMed
48.
Friedman SM, Mendelson DA, Kates SF, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 56(7):1349–1356CrossRefPubMed
49.
Kelly H, Hurst J (2006) Health care quality indicators project initial indicators report. OECD Health Working Paper No. 22
Metadata
Title
A multicenter survey on profile of care for hip fracture: predictors of mortality and disability
Authors
S. Maggi
P. Siviero
T. Wetle
R. W. Besdine
M. Saugo
G. Crepaldi
For the Hip Fracture Study Group
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 2/2010
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-0936-8

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