MORTALITY FOLLOWING DELAY TO SURGERY IN HIP FRACTURES IN THE PROVINCE OF ONTARIO

Abstract

Introduction and Aims: Surgical delays for non-medical reasons in the management of hip fractures may be detrimental to clinical outcomes. Prior literature is inconclusive, often because of insufficient power and failure to adjust for potential confounding factors. Our aim was to evaluate mortality following delay to surgery in hip fractures in the province of Ontario.

Method: All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 in the Province of Ontario were identified using administrative databases and the provincial mortality database. Multivariable logistic regression models were used to adjust for age, gender, medical comorbidity, type of hip fracture, and teaching status of the treating hospital.

Results: For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95% CI). The adjusted odds of in-hospital mortality increased as the delay to surgery lengthened from a factor of 1.2 [95% CI] with a one-day delay to a factor of 1.5 [95% CI] for a delay over two days as compared with patients operated within 24 hours. Similar relationships were observed at three months and one year. Even when considering only healthy patients, < 70 years old with no comorbid conditions, the relationship between mortality and surgical delay remained significant (p < 0.0001), suggesting that surgical delay was unlikely to be caused by patient factors alone.

Conclusion: A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for patients with fractured hips. This finding will have far-reaching implications for the allocation of health resources in the future.