THE EFFECT OF SURGICAL DELAY ON MORTALITY OF PATIENTS WITH HIP FRACTURES

Abstract

This study aimed to ascertain the effect of operative delay on mortality of patients with hip fractures excluding those delayed for medical reasons.

In our unit, patients with hip fractures (fractures of the femoral neck and trochanteric zone) have surgery on trauma operating lists shared with plastic surgery emergencies. They are not specifically prioritised and are operated on in order of admission. In a 6-month period, 221 consecutive patients over the age of 65 were planned for surgical treatment of their hip fracture in our unit. 16 patients had surgery delayed for medical reasons and were excluded from further analysis. In a further 9 patients it was not possible to confirm the exact delay to theatre from records and these were also excluded. This left 196 patients in whom it was possible to relate in-hospital and 90-day mortality to surgical delay.

These data demonstrate a significant trend towards increasing mortality with increasing delay (χ²-test for trend: p = 0. 0015 (in-hospital) and p = 0. 0021 (90-day)). Comparison of mortality between those delayed 2 days or less (164 patients) and those delayed more than 2 days (32 patients) was also highly significant (Fisher’s exact test: p = 0. 0008 (in-hospital) and p = 0. 0004 (90-day)).

We conclude that delays to surgery in patients with hip fractures, particularly beyond 2 calendar days, result in unacceptably high mortality. Practice should be modified to ensure these patients receive greater priority for theatre time.