DELAY TO SURGERY AND PERI-OPERATIVE MORTALITY AFTER HIP FRACTURE

Abstract

The aim of this study was to evaluate the peri-operative (30-day) mortality following hip fracture and look at the variables which influence early mortality after this injury. A prospective audit of all patients admitted with hip fracture was undertaken over an 18-month period. An independent research assistant collected data on a standardised questionnaire. Data included basic demographics, comorbidities, mental test score, mobility and social status, All patients received prophylactic antibiotics and thromboprophylaxis and surgery was undertaken on dedicated trauma and hip fracture operating lists.

There were 1072 patients admitted with hip fracture: 829 females (77%) and 240 males (23%) with a mean age of 80 years (range 24–103 years). The basic fracture types were intracapsular (n=616; 58%); extracapsular (n=414; 38%); subtrochanteric (n=29; 3%) and periprosthetic (n=12; 1%). 69 patients (7%) had acute medical problems which delayed anaesthesia. Delays to surgery, because of a lack of theatre resources, were common and only 314 patients (29%) had their hip fracture fixed on the day of admission or the following day. There were 9 deep infections (0. 8%) and 69 patients (6%) died within 30 days of surgery. Linear regression analysis showed that the 30-day mortality was not associated with pre-injury mobility or mental test score (p=0. 224). Any delay to surgery (2 days or more) resulted in a significant increase in mortality (p=0. 0042) and the risk of death increased 21% for every day surgery was delayed. Subgroup analysis showed that acute medical comorbidity was the most important factor influencing mortality with an odds ratio for death of 4. 9 (p=0, 0007). Delay to surgery in medically fit patients (n= 633) gave an odds ratio for death of 1. 6. In this group, the risk of death increased 16% for every day surgery was delayed with an 85% probability (p=O. 125) that this trend was significant.

The peri-operative mortality for hip fractures is now quite low (6%). Acute medical comorbidities are the most important cause of early post-operative death. Delay to surgery may be a factor in medically fit patients and our data suggests that the ideal time for surgery is the day after admission.