A three-year retrospective multi-center study on time to surgery and mortality for isolated geriatric hip fractures

Allen Tanner Ii; Stephanie Jarvis; Alessandro Orlando; Nnamdi Nwafo; Robert Madayag; Zachary Roberts; Chad Corrigan; Matthew Carrick; Pamela Bourg; Wade Smith; David Bar-Or

doi:10.1016/j.jcot.2019.12.001

A three-year retrospective multi-center study on time to surgery and mortality for isolated geriatric hip fractures

J Clin Orthop Trauma. 2020 Feb;11(Suppl 1):S56-S61. doi: 10.1016/j.jcot.2019.12.001. Epub 2019 Dec 6.

Authors

Affiliations

¹ Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA.
² ION Research, 383 Corona St. #319, Denver, CO, 80218, USA.
³ Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA.
⁴ St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO, 80228, USA.
⁵ Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA.
⁶ Wesley Medical Center, 550 N. Hillside St. Wichita, KS, 67214, USA.
⁷ Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA.

Abstract

Background: There are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost.

Methods: This was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost.

Results: There were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001.

Conclusions: The results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs.

Level of evidence: Level III.

Keywords: AAOS, American Academy of Orthopedic Surgeons; ACE, angiotensin-converting enzyme; AIS, Abbreviated Injury Scale; AOR, adjusted odds ratio; ASA, American Society of Anesthesiologists; AUC, area under the curve; CDC NDI, Centers for Disease Control National Death Index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; Geriatric hip fractures; HLOS, Hospital Length of Stay; IQR, interquartile range; Long-term mortality; OR, odds ratio; RR, respiratory rate; SBP, systolic blood pressure; SD, standard deviation; SE, standard error; TQIP, Trauma Quality Improvement Program; Time to surgery.