Neck of femur fractures in the elderly: Does every hour to surgery count?

OBJECTIVES

To determine if early surgery before 12h confers a survival or length of stay benefit for patients with neck of femur (NOF) fractures.

DESIGN

Retrospective review of prospectively collected data.

SETTING

District general hospital.

PATIENTS

1913 patients aged over 60 admitted with a fractured NOF who underwent surgery between 2011 and 2015. Mean age was 83.9 years. 73.7% were female.

INTERVENTION

Patients had surgery for fractured NOF with data collected on demographics, mortality and length of stay.

MAIN OUTCOME MEASUREMENTS

Data collected included gender, age, ASA grade, fracture anatomy, surgery, time to surgery, days spent in acute hospital and rehabilitation settings and 30-day mortality. Statistical analysis was used to identify independent predictors of mortality and length of stay.

RESULTS

30-day mortality was 6.1% and the mean hospitalisation time was 13±11.3days for the acute hospital and 20.2±17.2days for the trust. Operations were performed at a mean of 23.8±14.8h after presentation. Age, gender, ASA grade and type of fracture were independent predictors of either mortality or length of stay. Timing of surgery had an association with mortality but this only reached statistical significance at 24h. In line with previous studies we analysed time to surgery in 12h blocks. We also used logistic regression, recognizing time as a continuous variable, which revealed that every hour of delay to surgery increased the mortality risk by 1.8%.

CONCLUSIONS

While every hour of delay increased mortality risk, the association with mortality only became statistically significant when delaying over 24h. This supports a pragmatic approach, with surgery as soon as medically possible without a race to theatre.

LEVEL OF EVIDENCE

Level III retrospective cohort study.