Risk of mortality may be increased when hip fracture repair wait time exceeds 24 hours

Targeting surgery within 24 hours would represent a significant change in practice because the majority of patients did not receive surgery within this timeframe, study authors noted.

Patients with hip fractures who wait more than 24 hours to have surgery may be at increased risk of 30-day mortality and other complications compared to those who have surgery sooner, a recent retrospective study found.

To estimate when the risk of complications begins to increase from the time of hospital arrival to surgery, researchers reviewed population-based data on wait times among adults who had hip fracture surgery between April 1, 2009, and March 31, 2014, at 72 hospitals in Ontario. The primary outcome was 30-day mortality, and secondary outcomes were a composite of mortality or other medical complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia). The researchers modeled the risk-adjusted probability of each complication and compared patient outcomes using propensity-score matching. Results were published online on Nov. 28 by JAMA.

Among 42,230 patients (mean age, 80.1 years; 70.5% women) who had hip fracture surgery, overall 30-day mortality was 7%. Comorbidities were common and most often included hypertension, dementia, and diabetes.

The risk of any complication increased when wait times exceeded 24 hours, regardless of follow-up period or patient subgroup. The 13,731 patients who had surgery more than 24 hours after admission had a 30-day mortality risk of 6.5%, compared to 5.8% in 13,731 propensity-matched patients who had surgery earlier (absolute risk difference, 0.79%; 95% CI, 0.23% to 1.35%; P=0.006). They also had higher risk of the composite outcome (12.2% vs. 10.1%; absolute risk difference, 2.16%; 95% CI, 1.43% to 2.89%; P<0.001).

“Targeting surgery within 24 hours represents a significant change in practice because 66% of the patients in this study did not receive surgery within this timeframe,” the study authors noted. They added that limitations of the study include the possibility of unmeasured confounders and the omission of other clinically important complications, such as major bleeding.

An accompanying editorial pointed out that although the study was conducted in Canada, which affects the generalizability of the results to U.S. hospitals, sooner appears to be better than later when it comes to hip fracture surgery.

“Optimizing care for patients with hip fractures will require development of systems with more efficient preoperative patient evaluation and stabilization, more flexibility of scheduling and surgical workforce capacity, and effective approaches to ensure surgical repair as early as possible, ideally within 24 hours as the standard rather than the exception,” the editorialists wrote.