Delaying Hip Fracture Surgery by 24 Hours Increases Mortality Risk

Delaying hip fracture surgery beyond 24 hours increases the risk for 30-day mortality and other complications, according to a recent study.

The population-based, retrospective study included 42,230 patients who underwent hip fracture surgery between April 1, 2009 and March 31, 2014 (mean age 80.1 years, 70.5% women). Early and delayed surgery was defined by the inflection point (in hours) when complications began to increase. The probability of mortality within 30 days was calculated as the main outcome, and a composite of mortality and other medical complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia, was evaluated as the secondary outcome.
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After 30 days, 7% of the patients died. The researchers found that the risk for complications increased when wait times were greater than 24 hours, regardless of the complication. Additionally, patients who received surgery after 24 hours had a significantly higher risk for the composite outcome and 30-day mortality compared with those who received early surgery.

“Among adults undergoing hip fracture surgery, increased wait time was associated with a greater risk of 30-day mortality and other complications,” the researchers concluded. “A wait time of 24 hours may represent a threshold defining higher risk.”

—Melissa Weiss

Reference:

Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery [published online November 28, 2017]. JAMA. doi:10.1001/jama.2017.17606.