Top

Published in:

Open Access 01-12-2010 | Review

Does timing of surgery matter in fragility hip fractures?

Authors: F. Leung, T. W. Lau, K. Kwan, S. P. Chow, A. W. C. Kung

Published in: Osteoporosis International | Special Issue 4/2010

Abstract

The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements.

Hornby R, Evans JG, Vardon V (1989) Operative or conservative treatment for trochanteric fractures of the femur. A randomized epidemiological trial in elderly patients. J Bone Joint Surg Br 71:619–623PubMed

Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77(10):889–891CrossRefPubMed

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(3):361–366CrossRefPubMed

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(2):261–265CrossRefPubMed

Dorotka R, Schoechtner H, Buchinger W (2003) The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. Operation within six hours of the fracture versus later than six hours. J Bone Joint Surg Br 85(8):1107–1113CrossRefPubMed

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(1):29–33PubMed

Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332(7547):947–951CrossRefPubMed

McGuire KJ, Bernstein J, Polsky D, Silber JH (2004) The 2004 Marshall Urist award: delays until surgery after hip fracture increases mortality. Clin Orthop Relat Res 428:294–301CrossRefPubMed

Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E (2008) Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 90(1):34–42CrossRefPubMed

10.

Parker MJ, Pryor GA (1992) The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 74(2):203–205PubMed

11.

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(6):552–559CrossRefPubMed

12.

Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14(5):371–377CrossRefPubMed

13.

Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91(7):922–927CrossRefPubMed

14.

Holt G, Smith R, Duncan K, Finlayson DF, Gregori A (2008) Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the Scottish hip fracture audit. J Bone Joint Surg Br 90(10):1357–1363CrossRefPubMed

15.

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

16.

Mullen JO, Mullen NL (1992) Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res 280:214–222PubMed

17.

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

18.

Casaletto JA, Gatt R (2004) Post-operative mortality related to waiting time for hip fracture surgery. Injury 35(2):114–120CrossRefPubMed

19.

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(10):1551–1556PubMed

20.

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(8):788–795CrossRefPubMed

21.

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

22.

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 (Belle Mead NJ) 26(9):621–627

23.

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(3):483–489CrossRefPubMed

24.

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(2):83–86CrossRefPubMed

25.

Verbeek DO, Ponsen KJ, Goslings JC, Heetveld MJ (2008) Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop 32(1):13–18CrossRefPubMed

26.

Williams A, Jester R (2005) Delayed surgical fixation of fractured hips in older people: impact on mortality. J Adv Nurs 52(1):63–69CrossRefPubMed

27.

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(6):405–407CrossRefPubMed

28.

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(14):1738–1743CrossRefPubMed

29.

McLeod K, Brodie MP, Fahey PP, Gray RA (2005) Long-term survival of surgically treated hip fracture in an Australian regional hospital. Anaesth Intensive Care 33(6):749–755PubMed

30.

Elder GM, Harvey EJ, Vaidya R, Guy P, Meek RN, Aebi M (2005) The effectiveness of orthopaedic trauma theatres in decreasing morbidity and mortality: a study of 701 displaced subcapital hip fractures in two trauma centres. Injury 36(9):1060–1066CrossRefPubMed

31.

Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture—an autopsy study. Injury 26(4):237–240CrossRefPubMed

32.

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(5):513–520CrossRefPubMed

33.

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(9):702–709CrossRefPubMed

34.

Fox HJ, Pooler J, Prothero D, Bannister GC (1994) Factors affecting the outcome after proximal femoral fractures. Injury 25(5):297–300CrossRefPubMed

35.

Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T, Hedström M (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

36.

Shabat S, Heller E, Mann G, Gepstein R, Fredman B, Nyska M (2003) Economic consequences of operative delay for hip fractures in a non-profit institution. Orthopedics 26(12):1197–1199, discussion 1199PubMed

37.

Hamilton BH, Hamilton VH, Mayo NE (1996) What are the costs of queuing for hip fracture surgery in Canada? J Health Econ 15(2):161–185CrossRefPubMed

38.

Thomas S, Ord J, Pailthorpe C (2001) A study of waiting time for surgery in elderly patients with hip fracture and subsequent in-patient hospital stay. Ann R Coll Surg Engl 83(1):37–39PubMed

39.

Doruk H, Mas MR, Yildiz C, Sonmez A, Kýrdemir 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(2):179–185CrossRefPubMed

40.

Siegmeth AW, Gurusamy K, Parker MJ (2005) Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 87(8):1123–1126CrossRefPubMed

41.

Bergeron E, Lavoie A, Moore L, Bamvita JM, Ratte S, Gravel C, Clas D (2006) Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma 60(4):753–757CrossRefPubMed

42.

Harries DJ, Eastwood H (1991) Proximal femoral fractures in the elderly: does operative delay for medical reasons affect short-term outcome? Age Ageing 20(1):41–44CrossRefPubMed

43.

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(7):1499–1518PubMed

44.

Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 293(6556):1203–1204CrossRef

45.

Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ (2009) Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients. Injury 40(7):692–697CrossRefPubMed

46.

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

47.

Scottish Intercollegiate Guidelines Network (SIGN) (2009) Management of hip fracture in older people. A national clinical guideline. SIGN, Edinburgh

48.

British Orthopaedic Association Standards for Trauma (BOAST): Hip fracture in the older person. September 2007.

49.

Royal College of Physicians of London (1999) Osteoporosis: clinical guidelines for prevention and treatment. RCP, London

Title: Does timing of surgery matter in fragility hip fractures?
Authors: F. Leung
T. W. Lau
K. Kwan
S. P. Chow
A. W. C. Kung
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue Special Issue 4/2010
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1391-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Does timing of surgery matter in fragility hip fractures?

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 4/2010

Surgery for fragility hip fracture—streamlining the process

Hip fracture audit: the Nottingham experience

Management of osteoporosis in patients hospitalized for hip fractures

Preoperative cardiac risk assessment in geriatric patients with hip fractures: an orthopedic surgeons’ perspective

Co-managed care for fragility hip fractures (Rochester model)

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?