Research article

The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures

Rüdiger Smektala¹ , Heinz G Endres² , Burkhard Dasch³ , Christoph Maier⁴ , Hans J Trampisch² , Felix Bonnaire⁵ and Ludger Pientka⁶

¹  University Clinic for Surgery, Department of Trauma Surgery, Knappschafts Hospital Bochum-Langendreer, Ruhr University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany

²  Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, D-44801 Bochum, Germany

³  Department of Anesthesiology and Intensive Care, University Hospital of Münster, D-48149 Münster, Germany

⁴  Clinic for Anesthesiology, Intensive, Palliative and Pain Medicine, Department of Pain Therapy, BG Klinikum Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany

⁵  Trauma Surgery Clinic, Municipal Hospital Dresden-Friedrichsstadt, D-01067 Dresden, Germany

⁶  Clinic for Geriatrics, Ruhr University Bochum, Marienhospital Herne, D-44627 Herne, Germany

author email corresponding author email

BMC Musculoskeletal Disorders 2008, 9:171doi:10.1186/1471-2474-9-171

Published:	29 December 2008

Abstract

Background

Whether reducing time-to-surgery for elderly patients suffering from hip fracture results in better outcomes remains subject to controversial debates.

Methods

As part of a prospective observational study conducted between January 2002 and September 2003 on hip-fracture patients from 268 acute-care hospitals all over Germany, we investigated the relationship of time-to-surgery with frequency of post-operative complications and one-year mortality in elderly patients (age ≥65) with isolated proximal femoral fracture (femoral neck fracture or pertrochanteric femoral fracture). Patients with short (≤12 h), medium (> 12 h to ≤36 h) and long (> 36 h) times-to-surgery, counting from the time of the fracture event, were compared for patient characteristics, operative procedures, post-operative complications and one-year mortality.

Results

Hospital data were available for 2916 hip-fracture patients (mean age (SD) in years: 82.1 (7.4), median age: 82; 79.7% women). Comparison of groups with short (n = 802), medium (n = 1191) and long (n = 923) time-to-surgery revealed statistically significant differences in a few patient characteristics (age, American Society of Anesthesiologists ratings classification and type of admission) and in operative procedures (total hip endoprosthesis, hemi-endoprosthetic implants, other osteosynthetic procedures). However, comparison of these same groups for frequency of postoperative complications revealed only some non-significant associations with certain complications such as post-operative bleeding requiring treatment (early surgery patients) and urinary tract infections (delayed surgery patients). Both unadjusted rates of one-year all-cause mortality (between 18.1% and 20.5%), and the multivariate-adjusted hazard ratios (HR for time-to-surgery: 1.04; p = 0.55) showed no association between mortality and time-to-surgery.

Conclusion

Although this study found a trend toward more frequent post-operative complications in the longest time-to-surgery group, there was no effect of time-to-surgery on mortality. Shorter time-to-surgery may be associated with somewhat lower rates of post-operative complications such as decubitus ulcers, urinary tract infections, thromboses, pneumonia and cardiovascular events, and with somewhat higher rates of others such as post-operative bleeding or implant complications.