Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 5

Hip Fracture: Risk Factors of Delay and Appropriate Timing to Surgery

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

Abstract

Background: “Patients with a hip fracture may be appropriately delayed for surgery as they require optimization or clinical interventions to treat acute medical illnesses” [12]. “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

References

  1. Anna Nilsdotter and Ann Bremander. “Measure of hip function and symptoms”. Arthritis Care and ResearchS11 (2011): S200-S207.
  2. Bhattacharyya T., et al. “Rate of risk factors for acute inpatient mortality after orthopedic surgery”. Journal of Bone and Joint Surgery 84 (2002): 562-572.
  3. Brenner S. “Optimal timing for hip fracture surgery: a rapid review”. Toronto, ON: Health Quality Ontario (2013): 1-19.
  4. Carulli C., et al. “Surgical prosthetic treatment”. Clinical Cases in Mineral and Bone Metabolism 7 (2010): 32-38.
  5. Cooper C., et al. “Hip fractures in the elderly: a world-wide projection”. Osteoporosis International 2 (1992): 285-289.
  6. Harris WH. “Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end‐result study using a new method of result evaluation”. Journal of Bone and Joint Surgery 51 (1969): 737-755.
  7. Innocenti M., et al. “Proximal femural fractures: epidemiology”. Clinical Cases in Mineral and Bone Metabolism 6 (2009): 117-119.
  8. Kalairajah Y., et al. “Health outcome measures in the evaluation of total hip arthroplasties: a comparison between the Harris Hip Score and the Oxford Hip Score”. Journal of Arthroplasty 20 (2005): 1037-1041.
  9. Khan SK., et al. “Timing of surgery for hip patients: A systematic review of 52 published studies involving 291,413 patients”. Injury 40 (2009): 692-697.
  10. Lee DJ and Elfar JC. “Timing of hip fracture surgery in the elderly”. Geriatric Orthopedic Surgery and Rehabilitation3 (2014): 138-140.
  11. Matthew R Cohn., et al. “Factors associated with early functional outcome after hip fracture surgery”. Geriatric Orthopedic Surgery and Rehabilitation1 (2016): 3-8.
  12. Moja L., et al. “Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients”. PLoS One10 (2012): e46175.
  13. Moja L., et al. “Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients”. PLoS One 7 (2012): e46175.
  14. Muhm M., et al. “Mortality and quality of life after proximal femur fracture: effect of time until surgery and reasons for delay”. European Journal of Trauma and Emergency Surgery 39 (2013): 267e275.
  15. Parker M and Johansen A. “Hip fracture”. BMJ 333 (2006): 27-30.
  16. Scottish Intercollegiate Guidelines Network. “Management of hip fracture in older people”. A national clinical guideline. NHS Scotland (2009).
  17. The Hip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators. “Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial”. CMAJ 186 (2014): 1.
  18. Willer TB., et al. “The effect of a pre- and postoperative orthogeriatrics service on cognitive function in patients with hip fracture. The protocol of the Oslo orthogeriatric trial”. Geriatrics 20 (2012): 12-36.
  19. Zuckerman JD. “Hip fracture”. The New England Journal of Medicine 334 (1996): 1519-1525.

Citation

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

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.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US