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Don't Delay Surgery After Hip Fracture

Patients who did not receive surgery within 24 hours of hip fracture had higher mortality rates.

Patients who sustain hip fractures do not always undergo surgery within 24 hours of the injury. To determine the consequences of such delays, investigators evaluated data from all U.K. hospitals with at least 100 admissions for femoral neck fracture between April 2001 and March 2004.

During the study period, 129,522 admissions occurred for femoral neck fracture among older patients (age, 65); 93% of patients underwent surgery. Forty percent of the procedures were performed more than 1 day after admission, and 21% were delayed for more than 2 days. Factors associated with delay included older age, female sex, low socioeconomic status, and comorbidity.

A total of 18,508 in-hospital deaths occurred during the study. After adjustment for confounding factors, delay in surgery was associated significantly with higher risk for in-hospital death (relative risk, 1.27 for delay 1 day). Had delays in surgery been avoided, the authors estimate that 9% of all hip-fracture–related deaths could have been averted in the U.K. each year. Delays in surgery were not associated with readmission rates.

Comment: These results support the practice of performing surgery for hip fracture within 24 hours. In another recent study, early surgery was associated with less pain and shorter length of stay but not with lower mortality rates (Journal Watch Apr 30 2004). At the time of publication, the full text of the original article was available free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine May 19, 2006

Citation(s):

Bottle A and Aylin P. Mortality associated with delay in operation after hip fracture: Observational study. BMJ 2006 Apr 22; 332:947-51.

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• Medline abstract (Free)