Acute Hip Fracture Surgery

A large study from Canada has recently been published in JAMA. It is a retrospective cohort study with propensity matching for comorbidities. The study is important because of (1) the propensity matching; (2) the number of patients, and (3) because the patients were studied by comparison of hours between the fracture and surgery rather than by allocation into larger groups (e.g. <24hrs, 24-48 hours; >48 hours etc) comparison between aggregated groups. The average delay between fracture and surgery was 38 hours. The study suggests that there is an incremental increase in complications and death at 30 days if surgery is delayed beyond 24 hours. The editorial also observes that “patients who underwent early surgery had fewer days of severe pain and fewer major complications. Even with the absence of definitive proof of harm, delaying surgery for no good reason is suboptimal care.”

Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318(20):1994-2003.
Mark S. Vrahas MS, Sax HC, Timing of Operations and Outcomes for Patients With Hip Fracture—It’s Probably Not Worth the Wait JAMA 2017; 318(20): 20 1981-2