Delayed surgical treatment of geriatric hip fractures increases the need for intensive care unit, morbidity and mortality rates

Yıl 2023, Cilt: 36 Sayı: 3, 326 - 333, 29.09.2023

Yavuz Şahbat , Tolga Onay , Ömer Sofulu , Oytun Derya Tunc Elif Nur Koçak , Bulent Erol

https://doi.org/10.5472/marumj.1367987

Öz

Objective: The aim of this study was to present the intensive care admission, morbidity and mortality rates of older adults with hip
fractures who could not be operated in the first 48 hours after admission, which is the recommended time in literature.
Patients and Methods: Patients aged >60 years of age with a hip fracture who were operated on in our clinic between January 2012
and June 2021 were identified. The patients were evaluated in 3 groups according to preoperative waiting time, as Group 1: 2-10 days,
Group 2: 11-20 days, and Group 3: ≥21 days.
Results: Mortality within 1 year was found to be 20% in Group 1, 31% in Group 2, and 50% in Group 3 (P=0.001). Preoperative waiting
time did not affect complications related to surgery infection (P=0.890), implant failure (P=0.129) but surgeons had to deal with
decubitus ulcer (P=0.016) and urinary tract infection (P=0.001). Patients with a long preoperative waiting time required preoperative
intensive care (P=0.003).
Conclusion: The study results demonstrate that as the preoperative waiting period increases, the mortality rate also increases, the need
for intensive care before and after the operation increases, and there is increased morbidity due to a long hospital stay.

Anahtar Kelimeler

Hip fracture, Preoperative waiting time, Intensive care unit

Kaynakça

• Maggi S, Kelsey J, Litvak J. Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int 1991; 1:232- 41. doi: 10.1007/BF03187467.
• Gullberg B, Johnell O, Kanis J. World-wide projections for hip fracture. Osteoporos Int 1997; 7:407-13. doi: 10.1007/ pl00004148.
• Kanis JA, Oden A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23:2239-56. doi: 10.1007/ s00198.012.1964-3
• Tuzun S, Eskiyurt N, Akarirmak U, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012;23:949-55. doi: 10.1007/s00198.011.1655-5
• Majumdar S, Beaupre L, Johnston W, et al. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective populationbased cohort study. Med Care 2006;44:552-9. doi: 10.1097/01. mlr.000.021.5812.13720.2e.
• Doruk H, Mas MR, Yıldız C, et al. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 2004;39:179-85. doi: 10.1016/j.archger.2004.03.004
• Kempenaers K, Van Calster B, Vandoren C, et al. Are the current guidelines for surgical delay in hip fractures too rigid? A single center assessment of mortality and economics. Injury 2018;49:1169-75. doi:10.1016/j.injury.2018.03.032.
• Borges FK, Bhandari M, Patel A, et al. Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip bmjopen-2018-028537.
• Della Rocca GJ, Crist BD. Hip fracture protocols: what have we changed? Orthop Clin North Am 2013; 44:163-82. doi: 10.1016/j.ocl.2013.01.009.
• Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 2012;7:e46175. doi: 10.1371/journal.pone.0046175.
• Maheshwari K, Planchard J, You J, et al. Early surgery confers 1-year mortality benefit in hip-fracture patients. Orthop Trauma 2018;32:105-10. doi: 10.1097/ BOT.000.000.0000001043.
• Chow SK-H, Qin J-h, Wong RM-Y, et al. One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry. J Orthop Surg Res 2018; 14;13:235. doi: 10.1186/s13018.018.0936-5.
• Cha Y-H, Ha Y-C, Yoo J-I, et al. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg 2017;137:625-30. doi: 10.1007/s00402.017.2674-2.
• Uzoigwe CE, Burnand HGF, Cheesman CL, et al. Early and ultra-early surgery in hip fracture patients improves survival. Injury 2013; 44:726-9. doi: 10.1016/j.injury.2012.08.025.
• Association BO. The care of patients with fragility fracture. London: British Orthopaedic Association 2007; 8-11.
• Leer-Salvesen S, Engesæter LB, Dybvik E, et al. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J 2019; 101-B:1129-37. doi: 10.1302/0301-620X.101B9.BJJ-2019-0295.R1
• Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1995; 77:1551-6. doi: 10.2106/00004.623.199510000-00010.
• Kawai M, Tanji A, Nishijima T, et al. Association between time to surgery and 90-day mortality after hip fracture: A retrospective cohort study of 1734 cases. J Orthop Sci 2018; 23:987-91. doi: 10.1016/j.jos.2018.07.016.
• Rai S, Varma R, Wani S. Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome? Eur J Orthop Surg Traumatol. 2018; 28:277-82. doi: 10.1007/s00590.017.2047-0.
• Marufu TC, Mannings A, Moppett IK. Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: qualitative systematic review. Injury 2015; 46:2325-34. doi: 10.1016/j.injury.2015.10.025
• Owens WD, Felts JA, Spitznagel Jr E. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978; 49:239-43. doi: 10.1097/00000.542.197810000-00003.
• Siegmeth A, Gurusamy K, Parker M. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 2005; 87:1123-6. doi: 10.1302/0301-620X.87B8.16357.
• Kalem M, Kocaoğlu H, Şahin E, et al. Impact of echocardiography on one-month and one-year mortality of intertrochanteric fracture patients. Acta Orthop Traumatol Turc 2018; 52:97-100. doi: 10.1016/j.aott.2017.12.006.
• Nwachuku IC, Jones M, Clough TM Clopidogrel: is a surgical delay necessary in fractured neck of femur? Ann R Coll Surg Engl 2011; 93:310-3. doi: 10.1308/rcsann.2011.93.4.310.
• Smith T, Pelpola K, Ball M, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014; 43:464-71. doi: 10.1093/ ageing/afu065.
• Vidán MT, Sánchez E, Gracia Y, et al. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med 2011 16;155:226-33. doi: 10.7326/0003-4819- 155-4-201108.160.00006.
• Johnstone D, Morgan N, Wilkinson M, et al. Urinary tract infection and hip fracture. Injury 1995; 26:89-91. doi: 10.1016/0020-1383(95)92183-b.
• Probst A, Reimers N, Hecht A, et al. Geriatric proximal femoral fracture and urinary tract infection-considerations for perioperative infection prophylaxis. Z Orthop Unfall 2016; 154:477-82. doi: 10.1055/s-0042-105767.
• Rønfeldt I, Larsen LK, Pedersen PU. Urinary tract infection in patients with hip fracture. Int J Orthop Trauma Nurs 2021; 41:100851. doi: 10.1016/j.ijotn.2021.100851.
• Magny E, Vallet H, Cohen-Bittan J, et al. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 2017 29;12:77. doi: 10.1007/s11657.017.0365-9
• Wei R, Chen H, Zha M-L, et al. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis. J Wound Care 2017 2;26:519-27. doi: 10.12968/jowc.2017.26.9.519
• Khor HM, Tan J, Saedon NI, et al. Determinants of mortality among older adults with pressure ulcers. Arch Gerontol Geriatr 2014; 59:536-41. doi: 10.1016/j.archger.2014.07.011.
• Eschbach D, Bliemel C, Oberkircher L, et al. One-year outcome of geriatric hip-fracture patients following prolonged ICU treatment. Biomed Res Int 2016; 8431213. doi: 10.1155/2016/8431213.
• Sofu H, Üçpunar H, Çamurcu Y, et al. Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture. Ulus Travma Acil Cerrahi Derg 2017;23:245-50. doi: 10.5505/tjtes.2016.84404.
• Hasan O, Mazhar L, Rabbani U, et al. Does early surgery prevent Postoperative ICU admission after surgery for the fracture of the hip. Nested case control study of 911 patients. Ann Med Surg (Lond) 2020 17;61:35-40. doi: 10.1016/j.amsu.2020.12.017.
• Yaacobi E, Marom O, Gutman N, et al. Mortality following surgery for geriatric hip fractures: is it the timing or the co-morbidities? Hip Int 2022; 32:271-5. doi: 10.1177/112.070.0020945942.
• Johansen A, Tsang C, Boulton C, et al. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia 2017; 72:961-6. doi: 10.1111/anae.13908.