The Impact of Time on Outcomes of Hip Fracture Surgery

New research highlights the crucial importance of timely hip fracture surgery. Delays, especially avoidable ones, are associated with worse patient outcomes, underscoring the need to optimize hospital processes to ensure rapid and effective care.

Key Findings

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

• Lack of operating room availability was the primary cause of avoidable delays.

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

• Patients with surgical delays tended to be sicker at presentation and had a longer hospital stay.

The Urgency of Hip Surgery

Hip fractures are devastating injuries with high mortality (approximately 20% at one year) and only half of survivors regain their pre-fracture level of function. Surgery is considered essential to improve mobility and reduce the risk of mortality. However, it is common for patients to wait more than two days for surgery, despite clinical guidelines recommending early surgery within 24 to 48 hours.

Causes of Surgical Delays

A prospective study conducted at a Level I trauma center identified that the main cause of delay in hip fracture surgery, beyond 48 hours, was the lack of operating room availability. Approximately 72% of avoidable delays were due to this reason. Unavoidable delays, though less frequent, were often related to the need for patient medical stabilization, such as decompensated heart failure or electrolyte abnormalities.

It was observed that 78% of delays (124 out of 160 patients) were considered potentially avoidable. Of these, the majority were due to limited operating room availability for orthopedic trauma. Other avoidable factors included inter-hospital transfers and, to a lesser extent, anticoagulant management and delayed diagnoses.

Implications for Patient Care

Patients who experienced surgical delays tended to present with a more delicate health status upon hospital admission and a longer duration of stay in the acute ward. Avoidable delays, particularly those related to operating room availability, represent a key area for quality improvement. Optimizing operating room resources and improving organizational processes are crucial to ensure that hip fracture patients receive necessary surgical care in a timely manner.

Research suggests that protecting operating room lists dedicated to trauma and prioritizing hip fracture patients are promising strategies. While medical delays are sometimes unavoidable, lack of preparedness or inefficient resource management can lead to unnecessary delays that negatively affect patient outcomes.

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.