Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2018-02, Vol.24 (1), p.32-37
• Main Authors: Chan, Y M, Tang, N, Chow, S K
• Format: Article
• Language: English
• Subjects: After-Hours Care; Aged; Aged, 80 and over; Emergencies; Female; Fractures; Hip Fractures - mortality; Hip Fractures - surgery; Hong Kong - epidemiology; Hospitals; Humans; Infections; Joint surgery; Male; Mortality; Older people; Patients; Personnel Staffing and Scheduling; Population; Postoperative Complications - epidemiology; Prostheses; Retrospective Studies; Surgical outcomes; Time Factors; Trauma; Treatment Outcome
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj165044

Surgery for hip fracture may be performed out-of-hours to avoid surgical delay. There is, however, a perception that this may constitute less-than-ideal conditions and result in a poorer outcome. The aim of this study was to evaluate the surgical outcome of elderly patients with hip fracture who underwent daytime versus out-of-hours surgery in Hong Kong. This will help make decisions about whether to operate out-of-hours or to delay surgery until the following day. This retrospective study included all elderly patients with hip fracture who were operated on and discharged from the Prince of Wales Hospital in 2014. Patients were divided into groups according to the time of surgical incision. Records were examined for 30-day mortality and postoperative surgical complications, and their potential associations with surgeon characteristics. Overall, 367 patients were selected in this study with 242 patients in the daytime group and 125 in the out-of-hours group. Demographic characteristics were comparable between the two groups. The overall 30-day mortality rate was 2.0% and the surgical complication rate was 24.2%. Compared with the daytime group, there was no increase in 30-day mortality or surgical complications for out-of- hours group. Fewer surgeons were involved in out-of-hours surgery but the number of surgeons and their qualifications did not affect the outcomes. The two groups were homogeneous in terms of demographic characteristics. Outcomes for 30-day mortality and postoperative surgical complications were comparable between the two groups. Surgeons' qualifications and number of surgeons involved were also not associated with the outcomes. Out-of-hours surgery remains a viable option in order to facilitate early surgery.