What is the optimal timing of hip fracture surgery?

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Published in the Canadian Medical Association Journal, Sobolev and colleagues assess mortality and provide timing guidelines for hip fracture surgery.

 

Hip fractures are extremely common and lead to death in 5% to 10% of patients within 30 days. Surgery typically improves survival, and surgery within 48 hours of hip fracture is recommended, but delays can occur. In a new paper in CMAJ, Sobolev and colleagues investigate how those delays affect patient mortality. Understanding the risks of these delays will greatly improve care and prioritization in hospitals.

Sobolev and colleagues used patient records from the Canadian Institute of Health and compared the risk of death if hip fracture surgery occurred on the day of admission, the day after admission, the third day, or after the third day. Their study included a total of 139,119 patient records of individuals aged 65 and older throughout Canada. The majority were women.

The researchers found that the death rate for surgeries conducted on the day of admission or the day after was 42.1 deaths per 1000 surgeries, whereas the death rate for surgeries conducted on the third day or after was 53.1 deaths per 1000 surgeries. There was no significant difference in mortality for surgeries conducted on the day of admission or the day after (48.9 versus 48 deaths per 1000 surgeries), but mortality skyrocketed for surgeries performed on the third day (57 deaths per 1000 surgeries) or after (69.1 deaths per 1000 surgeries). It is unlikely that some unknown cause led to these differences in mortality rate.

The results of Sobolev and colleagues’ study suggest that waiting more than 48 hours to perform hip fracture surgery could lead to an additional 11 deaths per 1000 surgeries—delay accounts for about 16.5% of deaths after admission. Although there are many different needs between patients and differences in treatment among doctors, this study provides a concrete assessment that can help guide treatment guidelines.

Written by C.I. Villamil

Reference: Sobolev et al. Mortality effects of timing alternatives for hip fracture surgery. CMAJ (2018) 190:E923-32.

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