BACKGROUND AND PURPOSE:

• Delaying hip fracture surgery is associated with increased mortality risk
  • Wait time to surgery is used as a quality metric
  • Data on optimal time-to-surgery is limited
• Pincus et al. (JAMA, 2017) sought to discover if there is an optimal time frame from emergency room to hip fracture repair

METHODS:

• Population-based, retrospective cohort study
• Patients: Adults undergoing hip fracture surgery between 2009-2014
• Main exposure: Wait time to surgery from arrival in the emergency department until surgery (hours)
• Primary outcome was mortality within 30 days
• Secondary outcome was a composite of mortality or other medical complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia)

RESULTS:

• 42,230 patients were included
  • Mean (SD) age, 80.1 years (10.7)
  • 70.5% women
  • Mean time to surgery was 38.8 (28.8) hours
• Overall, mortality at 30 days was 7.0%
• Risk of complications increased when wait times were greater than 24 hours, regardless of the specific complication
• 13,731 patients who received surgery within 24 hours (early) were propensity-score matched to patients who received surgery >24 hours (delayed) to adjust for confounders
  • 30 day mortality was 5.8% in the early group vs 6.5% in the delayed group
    • Absolute risk difference 0.79% (95% CI, 0.23%-1.35%)
  • Composite outcome (mortality + complications) was 10.1% in the early group vs 12.2% in the delayed group
    • Absolute risk difference 2.16% (95% CI, 1.43%-2.89%)
  • Risk of complications increased when wait times were greater than 24 hours, regardless of the specific complication

CONCLUSION:

• Increased wait time for hip replacement surgery was associated with a greater risk of mortality and other complications
• The authors suggest that a 24-hour window could serve as a wait time threshold for patients with hip fracture upon arrival to the emergency department

Learn More – Primary Sources:

Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery

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