Abstract
Previous studies on the timing of hip fracture surgery provide limited and conflicting evidence as to whether early operative intervention influences length of hospital stay, functional outcome and mortality rate. The aim of this study was to determine in a large, consecutive and prospectively followed group of patients the effect of a delay to surgery other than for medical reason. Patients who met the following criteria were included in the study: 1) Fragility fracture of the proximal femur. 2) Age over 60. 3) Complete data sets. 4) Complete follow up. Excluded patients were: 1) Younger than 60 years of age. 2) Conservative fracture treatment. 3) Pathological fracture. 4) Delay from admission to surgery for any medical reason. All patients were subdivided into six groups according to the delay between admission and operation (A:1–12 hours, B:13–24 hours, C:25–36 hours, D:37–48 hours, E:49–72 hours, F:73 + hours). All patients were followed up for one year or until death. Data on the mean length of hospital stay and the discharge destination as a parameter for the functional outcome were analysed in each of the six groups. A total of 3628 patients met the inclusion criteria. The average age was 81 years. 95.2% of patients were operated on between 1 and 48 hours after the admission, and 4.8% between 49 or more hours after the admission. Reason for delay was either lack of theatre time or unavailability of a surgeon or an anaesthetist. Statistical analysis with the unpaired t-test showed a significant difference in the hospital length of stay of 21 days for patients operated within 48 hours of admission versus 32 days for patients operated after 48 hours (p The functional outcome was significantly worse in the group with a delay of more than 48 hours with only 71% of patients discharged to their own home (86% in the early group, p< 0.0001). This study provides further and conclusive evidence that early operative intervention in elderly patients with fragility fractures of the proximal femur results in a decreased hospital stay and a better functional outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
