Are the current guidelines for surgical delay in hip fractures too rigid? A single center assessment of mortality and economics

Publication date: Available online 27 March 2018
Source:Injury
Author(s): Kristof Kempenaers, Ben Van Calster, Cindy Vandoren, An Sermon, Willem-Jan Metsemakers, Paul Vanderschot, Dominique Misselyn, Stefaan Nijs, Harm Hoekstra
PurposeControversy remains around acceptable surgical delay of acute hip fractures with current guidelines ranging from 24 to 48 hours. Increasing healthcare costs force us to consider the economic burden as well. We aimed to evaluate the adjusted effect of surgical delay for hip fracture surgery on early mortality, healthcare costs and readmission rate. We hypothesized that shorter delays resulted in lower early mortality and costs.MethodsIn this retrospective cohort study 2573 consecutive patients aged ≥50 years were included, who underwent surgery for acute hip fractures between 2009 and 2017. Main endpoints were thirty- and ninety-day mortality, total cost, and readmission rate. Multivariable regression included sex, age and ASA score as covariates.ResultsThirty-day mortality was 5% (n = 133), ninety-day mortality 12% (n = 304). Average total cost was €11960, dominated by hospitalization (59%) and honoraria (23%). Per 24 hours delay, the adjusted odds ratio was 1.07 (95% CI 0.98–1.18) for thirty-day mortality, 1.12 (95% CI 1.04–1.19) for ninety-day mortality, and 0.99 (95% CI = 0.88–1.12) for readmission. Per 24 hours delay, costs increased with 7% (95% CI 6–8%). For mortality, delay was a weaker predictor than sex, age, and ASA score. For costs, delay was the strongest predictor. We did not find clear cut-points for surgical delay after which mortality or costs increased abruptly. The adjusted odds ratio was 0.99 (95% CI = 0.88–1.12) for readmission.ConclusionsDespite only modest associations with mortality, we observed a steady increase in healthcare costs when delaying surgery. Hence, a more pragmatic approach with surgery as soon as medically and organizationally possible seems justifiable over rigorous implementation of the current guidelines.



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