Expedited Surgery Imperative for Post-Hip Fracture Survival

Surgery on admission day or the following day reduces postoperative mortality among medically stable patients with hip fracture, according to a new study.

Researchers at the University of British Columbia (UBC; Vancouver, Canada), the University of Toronto (UT; Canada), and other institutions analyzed data regarding 139,119 medically stable patients with first-time hip fracture (65 years or older, 74% female) who underwent surgery at 144 hospitals throughout Canada--excluding the province of Quebec--between 2004 and 2012. Expected population-average risks of inpatient death within 30 days were calculated for patients surgically treated on the day of admission, inpatient day two, day three, or after day three.

The results revealed that 23.1% underwent surgery on admission day, 43.5% underwent surgery on inpatient day two, 21% on day three, and 12.4% at a later date. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day three. The researchers projected an additional 10.9 deaths per 1,000 surgeries if all surgeries were done after inpatient day three instead of admission day. The study was published on August 7, 2018, in the Canadian Medical Association Journal (CMAJ).

“Our findings allow us to infer a critical point for the timing of hip fracture repair. We suggest that clinicians, administrators, and policy-makers 'not let the sun set twice' on medically stable older adults before their hip fracture repair,” said co-lead author orthopedic surgeon Pierre Guy, MD, of UBC. “We estimate that 16.5% of in-hospital deaths currently occurring in patients delayed for more than two days are avoidable by adopting the 'don't let the sun set twice' policy for hip fracture patients.”

Canadian hospitals admit 30,000 older adults with hip fracture annually. Such patients face an increased risk of death, with up to 5% of women and 10% of men dying within 30 days. Early surgical intervention improves survival by reducing patients’ exposure to immobilization and inflammation. In 2005, Canada established a benchmark of 48 hours from admission for 90% of hip fracture surgeries so as to prevent potentially harmful delays. But delays remain common, and many patients who are medically stable at presentation may have to wait until a surgeon or an operating room becomes available.

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University of British Columbia
University of Toronto