Time to Surgery Is Associated with Thirty-Day and Ninety-Day Mortality After Proximal Femoral Fracture: A Retrospective Observational Study on Prospectively Collected Data from the Danish Fracture Database Collaborators

A. M. Nyholm, K. Gromov, H. Palm, M. Brix, T. Kallemose, A. Troelsen

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Abstract

Background: We hypothesized that undergoing surgery as soon as possible reduces early mortality in patients with a proximal femoral fracture. Our aim was to evaluate the association between surgical delay and earlymortality in these patients. Methods: We performed a retrospective analysis of prospectively collected data from the Danish Fracture Database and the Civil Registration System on patients who were fifty years of age or older and had undergone surgery for a proximal femoral fracture. Femoral head fracture (classified as OTA/AO 31C per the OTA/AO classification system), high-energy trauma, pathological fractures, multiple fractures, and surgeries performed with implants not commonly used were excluded. End points were adjusted odds ratios for thirty-day and ninety-day mortality. Results: For the 3517 surgeries included in this study, the median patient age was 82.0 years (range, fifty-one to 107 years), 2458 patients (70%) were female, and 1720 surgeries (49%) were performed because of a trochanteric fracture. Within twelve hours, 722 of the surgeries (21%) had been performed; within twenty-four hours, 2482 surgeries (71%); within thirty-six hours, 3024 surgeries (86%); within forty-eight hours, 3242 surgeries (92%); and within seventy-two hours, 3353 surgeries (95%). Unsupervised surgeons with an education level below that of an attending surgeon performed the surgery in 1807 (51%) of all cases. The thirty-day mortality was 380 (10.8%) and the ninety-day mortality was 612 (17.4%). The risk of thirty-day mortality increased with a surgical delay of more than twelve hours (odds ratio, 1.45; p = 0.02), more than twenty-four hours (odds ratio, 1.34; p = 0.02), and more than forty-eight hours (odds ratio, 1.56; p = 0.02); the risk of ninety-daymortality increased with a surgical delay of more than twenty-four hours (odds ratio, 1.23; p = 0.04). An education level of the surgeon below that of an attending surgeon increased the risk of thirty-day mortality (odds ratio, 1.28; p = 0.035) and ninety-daymortality (odds ratio, 1.26; p = 0.016). Increasing American Society of Anesthesiologists score andmale sex significantly increased both thirty-day and ninety-day mortality.

OriginalsprogEngelsk
TidsskriftJournal of Bone and Joint Surgery: American Volume
Vol/bind97
Udgave nummer16
Sider (fra-til)1333-1339
ISSN0021-9355
DOI
StatusUdgivet - 2015

Emneord

  • aged *cause of death cohort analysis Denmark factual database female follow up Hip Fractures/su [Surgery] human intramedullary nailing male middle aged *mortality multivariate analysis procedures prospective study radiography retrospective study risk assessment statistical model survival rate time *time to treatment treatment outcome very elderly

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