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

TY - JOUR

T1 - Time to Surgery Is Associated with Thirty-Day and Ninety-Day Mortality After Proximal Femoral Fracture

T2 - A Retrospective Observational Study on Prospectively Collected Data from the Danish Fracture Database Collaborators

AU - Nyholm, Anne Marie

AU - Gromov, Kirill

AU - Palm, Henrik

AU - Brix, Michael

AU - Kallemose, Thomas

AU - Troelsen, Anders

AU - Danish Fracture Database Collaborators

N1 - Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

PY - 2015/8/19

Y1 - 2015/8/19

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Cause of Death

KW - Cohort Studies

KW - Databases, Factual

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Fracture Fixation, Intramedullary

KW - Hip Fractures

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Assessment

KW - Survival Rate

KW - Time Factors

KW - Time-to-Treatment

KW - Treatment Outcome

U2 - 10.2106/JBJS.O.00029

DO - 10.2106/JBJS.O.00029

M3 - Journal article

C2 - 26290084

SN - 0021-9355

VL - 97

SP - 1333

EP - 1339

JO - Journal of Bone and Joint Surgery: American Volume

JF - Journal of Bone and Joint Surgery: American Volume

IS - 16

ER -