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A delay of 2 or more days in surgical repair of hip fracture substantially increases mortality rates

An estimated 14 to 36 percent of individuals who suffer a hip fracture die within a year of the fracture. Delay of hip fracture repair surgery increases the risk of dying within a month, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09460). The study found that patients with a closed hip fracture who had a delay in surgery of 2 or more days after hospital admission had a 17 percent higher chance of dying within 30 days than similar patients whose surgery was not delayed. Individuals whose surgery was delayed 3 or more days had a 21 percent higher chance of dying within a month.

Jeffrey H. Silber, M.D., Ph.D., of the Center for Outcomes Research, Philadelphia, and colleagues used the Pennsylvania Medicare database from 1995-1996 to examine the relationship between time from hip fracture diagnosis to surgical repair and death within 30 days for 18,209 Medicare patients aged 65 or older. Overall, 81 percent of patients were admitted from the emergency department, and 48 percent had other preexisting medical problems.

Nearly 7 percent of patients died within 30 days of hospital admission. Those whose surgery was delayed 2 or more days had a 17 percent higher risk of dying within a month, even after adjusting for severity of illness. Day of the week, as expected, correlated with treatment. The mean time from admission to surgery was 1.17 days. However, admission on Saturday, Sunday, or Monday was associated with a mean delay of 1.22 days and was highly predictive of a delay in surgery of 2 or more days. Patients admitted Tuesday, Wednesday, Thursday, or Friday had a mean delay of 1.13 days. In clinical practice, the sickest patients most often have a deliberate delay to optimize their health status before surgery. They also are the patients most likely to die.

See "Delays until surgery after hip fracture increases mortality," by Kevin J. McGuire, M.D., M.S.C.E., Joseph Bernstein, M.D., M.S., Daniel Polsky, Ph.D., and Jeffrey H. Silber, M.D., Ph.D., in the November 2004 Clinical Orthopaedics and Related Research 428, pp. 294-301.

Editor's Note: Another AHRQ-supported study on a related topic found that patients with elevated risk of relocation after hip fracture may be targets for intensive care coordination and care planning interventions. For more details, see Boockvar, K.S., Litke, A., Penrod, J.D., and others (2004). "Patient relocation in the 6 months after hip fracture: Risk factors for fragmented care." (AHRQ grants HS09973 and HS09459). Journal of the American Geriatrics Society 52, pp. 1826-1831.

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