Delaying Surgery for Hip Fracture for More Than One Day Associated with Small Increased Risk of Death

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 28, 2017

Media advisory: To contact corresponding author Daniel Pincus, M.D., email Heidi Singer at Heidi.Singer@utoronto.ca. The full study is available on the For The Media website.

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Bottom Line:  Waiting more than 24 hours to undergo hip fracture surgery may be associated with an increased risk of death and complications.

Why The Research Is Interesting: Disagreements remain about acceptable delay for surgical repair of hip fracture. Guidelines in the U.S. and Canada recommend surgery within 48 hours.

Who and When: 42,230 adults who had hip fracture surgery between April 2009 and March 2014 at 72 hospitals in Ontario, Canada.

What (Study Measures): Time in hours from emergency department arrival until surgery (exposure); death within 30 days of hospital admittance for hip fracture surgery (outcome).

How (Study Design): This is an observational study. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings. In observational studies, researchers observe exposures and outcomes for patients as they occur naturally in clinical care or real life. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings so they cannot prove a cause-and-effect relationship.

Authors: Daniel Pincus, M.D., of the University of Toronto, and coauthors

Results: Patients who had surgery for hip fracture after 24 hours had an increased risk of death compared to patients who had surgery within 24 hours (6.5 percent vs 5.8 percent). The risk of complications, such as heart attack, deep vein thrombosis, pulmonary embolism, and pneumonia, were also higher for patients who had surgery after 24 hours.

Study Limitations: Sick patients who may have died awaiting surgery were not included in the study.

Featured Image:

 

What The Image Shows: Gradual increase in risk of death by wait time for hip fracture surgery. Risk seems to decrease slightly until a 24 hour delay, at which time risk begins to increase continuously with time (Click on the image for a full-size version. Right click to “save image as” to download.)

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(doi:10.1001/jama.2017.17606)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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