Early Operation on Patients with a Hip Fracture Improved the Ability to Return to Independent Living: A Prospective Study of 850 Patients

• Published in: Journal of bone and joint surgery. American volume 2008-07, Vol.90 (7), p.1436-1442
• Main Authors: Al-Ani, Amer N, Samuelsson, Bodil, Tidermark, Jan, Norling, Åsa, Ekström, Wilhelmina, Cederholm, Tommy, Hedström, Margareta
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Caring sciences; Diseases of the osteoarticular system; Female; Hip Fractures - mortality; Hip Fractures - surgery; Hip Fractures/mortality/surgery; Humans; Incidence; Injuries of the limb. Injuries of the spine; INTERDISCIPLINARY RESEARCH AREAS; Length of Stay; Male; Medical sciences; Medicin och hälsovetenskap; Orthopedic Procedures; Orthopedic surgery; Pressure Ulcer - epidemiology; Prospective Studies; Quality of Life; Recovery of Function; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; TVÄRVETENSKAPLIGA FORSKNINGSOMRÅDEN; Vårdvetenskap
• ISSN: 0021-9355; 1535-1386; 1535-1386
• DOI: 10.2106/JBJS.G.00890

BackgroundThe outcome for many patients with a hip fracture remains poor. The aim of the present study was to investigate whether the timing of surgery in such patients could influence the short-term clinical outcome.MethodsWe included 850 consecutive patients with a hip fracture who were admitted to the hospital during one year in a prospective study. Three cutoff limits for a comparison of early and late operation were defined. The outcome (the ability to return to independent living, risk for the development of pressure ulcers, length of the hospital stay, and mortality rate) for patients who had an operation within twenty-four, thirty-six, and forty-eight hours was compared with the outcome for those who had an operation at a later time.ResultsPatients who had the operation more than thirty-six and forty-eight hours after admission were less likely to return to independent living within four months (odds ratio, 0.44 and 0.33, respectively), whereas there was no significant difference with use of the twenty-four-hour cutoff limit. The incidence of pressure ulcers in the groups that had the operation later was increased at all three cutoff limits (a delay of more than twenty-four hours, more than thirty-six hours, and more than forty-eight hours) (odds ratio, 2.19, 3.42, and 4.34, respectively). The length of hospitalization was also increased in the groups that had the later operation (median, fourteen compared with eighteen days, fifteen compared with nineteen days, and fifteen compared with twenty-one days, respectively) (p < 0.001 for all comparisons). The importance of surgical timing remained significant after adjusting for several possible confounders (p < 0.05).ConclusionsEarly compared with late operative treatment of patients with a hip fracture is associated with an improved ability to return to independent living, a reduced risk for the development of pressure ulcers, and a shortened hospital stay.Level of EvidenceTherapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.