The Crucial Impact of Time in Hip Fracture Surgery: New Findings

New research highlights the critical importance of surgical timing for hip fracture patients. Delays, especially avoidable ones, are associated with worse outcomes, underscoring the need to optimize hospital processes to ensure timely care and improve patient recovery.

Key Findings

• 37% of hip fracture patients experienced surgical delays beyond 48 hours.

• The main cause of avoidable delay was lack of operating room availability.

• Unavoidable delays were often due to the need for patient medical stabilization.

• Patients with surgical delays tended to have a more delicate health status and a longer hospital stay.

The Urgency of Hip Surgery

Hip fractures are serious injuries that often result in high mortality and limited functional recovery. Early surgery, ideally within 24 to 48 hours of admission, is considered crucial to improve mobility and reduce the risk of complications and mortality. However, studies indicate that a significant number of patients do not receive surgery within this recommended timeframe.

Causes of Surgical Delays

A prospective study conducted at a Level I trauma center identified that the lack of availability of orthopedic operating rooms was the most common reason for avoidable delays in hip surgery, accounting for 72% of avoidable delays. This often occurs when access to operating rooms is compromised, even if hip fracture patients are prioritized on the waiting list.

Other causes of delay included inter-hospital transfers (10% of avoidable delays) and medical reasons (approximately 3% of avoidable delays). Unavoidable delays, which accounted for 17% of all delays, were primarily due to the need for patient medical stabilization, such as managing decompensated heart failure or electrolyte abnormalities, as well as delayed consent signing.

Implications for Patient Care

The findings suggest that a substantial portion of hip fracture surgery delays are avoidable and are related to hospital capacity and resources, particularly operating room availability. Improving operational efficiency, protecting dedicated trauma operating room schedules, and optimizing inter-hospital transfer processes could significantly improve waiting times.

While delays due to medical reasons are often unavoidable, the research also noted that approximately 24% of delays unrelated to operating room availability did not result in a change in management, suggesting potential areas for optimizing clinical decision-making.

The research emphasizes the need for quality improvement interventions aimed at addressing systemic and organizational barriers that lead to avoidable delays, with the ultimate goal of improving outcomes for hip fracture patients.

Sources

• Avoidable and unavoidable delays in hip fracture surgery, boneandjoint.org.uk.

• Risk of acute renal failure and mortalityafter surgery for a fracture of the hip, boneandjoint.org.uk.