Ahmad K Abdallah* and Riad Fakih
Department of Orthopedic Surgery, Makassed General Hospital, Beirut, Lebanon
*Corresponding Author: Ahmad K Abdallah, Department of Orthopedic Surgery, Makassed General Hospital, Beirut, Lebanon.
Received: February 11, 2021; Published: April 06, 2022
Background: “Patients with a hip fracture may be appropriately delayed for surgery as they require optimization or clinical interventions to treat acute medical illnesses” . “Other patients are inappropriately delayed due to hospital factors” [3,10]. Effective admission and surgery in due time is well known as the best management course for these patients.
It is still not clear that the best time for the operation of hip fractures in older patients. We are aiming to examine the effect of the timing of surgical intervention on the occurrence of post-operative complications, recovery of weight bearing ability, and total hospitalization time.
Objectives: The goal of this study is to (1) identify the occurence of surgical delay in hip fractures, (2) evaluate the time point of surgical delay raises the risk of complications for patients, as well as recovery of weight bearing ability, total hospitalization time and (3) investigate the relation between the frequency of post-operative complications, mortality, quality of life and the timing of surgical repair.
Methods: A retrospective cohort study was conducted on patients with main diagnosis of hip fracture (femur neck and peritrochenteric fractures), aged 60 years and older, who underwent surgery in Makassed General Hospital between January 2010 and December 2015.
They were divided into two groups: an early surgery group (surgery done within 1 day after admission) and a delayed surgery group (surgery done after 1 day).
Clinical parameters that were analyzed included: the age of patients, their gender, their pre-injury ambulatory ability, the occurrence of admission during public holiday, fracture site and type, blood tests and urinalysis at admission, and chest radiography, electrocardiography, number of systemic chronic diseases, dementia, surgical modality, blood transfusion, length of hospital stay, ambulatory ability at discharge, and hospital death.
The Harris Hip Score system and Oxford Hip Score system were used to measure the physical and clinical outcome after 2 years follow up.
Results: Among 88 patients treated for hip fracture, 49 patients (55.6%) received early surgery, and 39 patients (44.4%) received late surgery. Multivariate analysis identified that admission during public holiday, electrocardiographic abnormalities, blood tests abnormalities, dementia, ambulatory discharge status, and length of hospital stay as significant independent factors.
Conclusion: Surgical delay of more than one day after admission in the setting of hip fractures is common and put patients at an increased risk of complications. The causes of surgical delay as cleared were admission during public holiday, ECG and blood tests abnormalities, and dementia. On the other hand, early surgery results in shorter hospital stay, lower incidence of dementia, and better ambulatory status after discharge. In addition, hip scoring showed better results in patients who underwent early surgery. It is recommending surgical intervention within 24 hours from hospital admission when possible. Healthcare systems can utilize these non-modifiable risk factors when performing quality assessment and cost accounting.
Keywords: Hip Fracture; Arthroplasty; Complications
Citation: Ahmad K Abdallah and Riad Fakih “Hip Fracture: Risk Factors of Delay and Appropriate Timing to Surgery".Acta Scientific Orthopaedics 5.5 (2022): 03-10.
Copyright: © 2022 Ahmad K Abdallah and Riad Fakih This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.