Relationship between one-year mortality in hip fractures and surgical delay

Abstract

Purpose

To analyze the relationship between surgical delay for hip fractures due to administrative-organizational reasons and the mortality index.

Materials and methods

We present a retrospective study of 634 hip fractures operated over a 5-year period. These also included patients whose surgery was postponed for organizational-administrative reasons but who were ready for surgery from the moment they were admitted. We excluded from the study patients who had a prior or an acute condition, patients under 65, patients with pathological fractures, multiple-trauma patients, and patients with anti coagulation or dementia. A comparison was made between the mortality rate of patients operated the same or the following day they were admitted with those operated the second or third days and with those operated after that time. Uni- and multivariate analyses were performed to analyze the relationship between surgical delay and several variables.

Results

About 18.6% of patients included in the study died at one year follow-up. Age, male gender and surgical risk were associated to higher mortality. The type of fracture, surgery or anesthesia did not influence final prognosis. Patients operated the same or the following day after admission had a lower mortality rate than those operated subsequently, regardless of age, gender or surgical risk.

Conclusions

The mortality index in autonomous patients, who did not present with an acute condition on admission and who were operated for a hip fracture the same or the following day they were admitted is significantly lower than that for patients operated at a later date.

Resumen

Objetivo

Analizar la relación entre el retraso en la cirugía de fractura de cadera por causas administrativoorganizativas y el índice de mortalidad.

Material y método

Estudio retrospectivo de 634 fracturas de cadera intervenidas durante 5 años que incluían a pacientes que retrasaron su cirugía por motivos administrativoorganizativos y preparados para cirugía desde el momento de su ingreso. Se excluyó a pacientes con enfermedad previa o agudizada, a menores de 65 años, con fracturas patológicas, politraumatizados, con anticoagulación o con demencia. Se comparó la mortalidad de los pacientes intervenidos el día de su ingreso o al siguiente día con los pacientes intervenidos el segundo o el tercer día y con los pacientes intervenidos más tarde. Se efectuó un análisis univariado y multivariado para estudiar la relación del retraso quirúrgico con diversas variables.

Resultados

El 18,6% de los pacientes incluidos falleció al año. La edad, el sexo masculino y el riesgo quirúrgico se asociaron a una mayor mortalidad. El tipo de fractura, la cirugía y la anestesia no influyeron en el pronóstico vital. Los pacientes intervenidos el día del ingreso o al día siguiente tuvieron menor mortalidad que los intervenidos más tarde, independientemente de la edad, el sexo o el riesgo quirúrgico.

Conclusiones

El índice de mortalidad en pacientes autónomos, sin enfermedad aguda al ingreso e intervenidos por fractura de cadera durante el primer día desde su ingreso hospitalario o al siguiente es significativamente menor al de los pacientes intervenidos más tarde.