Hip fracture surgery delays tied to higher odds of death

(Reuters Health) - Many patients with fractured hips don’t get surgery quickly enough to avoid an increased risk of complications and death, a Canadian study suggests.

Compared to patients who got hip fracture surgery within 24 hours after arriving at the hospital, people who waited longer for operations were more likely to have complications like heart attack, blood clots or pneumonia, the study found.

Overall, 5.8 percent of patients who had hip fracture surgery within 24 hours died, compared with 6.5 percent of people who had surgery later.

But only about one-third of patients got hip fracture surgery within 24 hours.

“Treatment within 24 hours is not only more humane for patients who wait bedridden in pain for surgery, but now has been shown to be associated with fewer complications,” lead study author Dr. Daniel Pincus of Sunnybrook Hospital and the University of Toronto said by email.

Guidelines in the U.S. and Canada recommend that patients receive surgery within 48 hours, Pincus and colleagues note in JAMA. The study results suggest that targeting a shorter wait time for surgery may improve outcomes, the research team concludes.

Researchers examined data on 42,230 adults who had hip fracture surgery at 72 hospitals in Ontario between 2009 and 2014.

Patients were 80 years old on average, and 71 percent were women.

On average, patients waited about 39 hours for surgery.

Overall, 7 percent of the patients died within 30 days of having hip fracture surgery, the study found.

Operating within 24 hours would prevent 79 deaths for every 100 patients treated, the researchers calculated.

It would also prevent 51 clots in the lungs, or pulmonary embolisms, as well as 39 heart attacks and 95 cases of pneumonia, they estimate.

The study wasn’t a controlled experiment, however, and it cannot prove whether or how shorter wait times for hip fractures surgery might influence the odds of complications or death.

Another limitation is that the researchers didn’t look at some complications that might be related to wait times for surgery such as serious bleeding. They also excluded people who died waiting for surgery, and it’s possible at least some of those patients might have had a different result with operations within 24 hours.

Even so, the findings suggest that as long as patients are otherwise healthy and an operating room is available, there isn’t a good reason to wait for surgery, Pincus said.

Operating sooner, however, may require doctors to rethink their approach to treating elderly patients with these injuries, said Dr. Harry Sax, author of an accompanying editorial and executive vice chair of surgery at Cedars-Sinai Medical Center in Los Angeles.

“We have to accept that an elderly patient who breaks a hip is already at increased risk for complications,” Sax said by email. “By putting them on bed rest for several days, we now make them more likely to get pneumonia, blood clots, pulmonary embolisms, or bed sores.”

Patients and families should be prepared for the possibility that a hip fracture may lead to declining health and death, particularly for frail elderly people, Sax added.

“Extensive delays may increase rather than reduce that risk,” Sax said.

SOURCES: and JAMA, online November 28, 2017.