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Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

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The Effect of Time-to-Surgery on Outcome in Elderly Patients with Proximal Femoral Fractures

Rüdiger Smektala1 / Burghard Dasch1 / Helmut Endres1 / Michael Lungenhausen1 / Christoph Mayer1 / Felix Bonnaire1 / Hans-Joachim Trampisch1 / Ludger Pientka1

Department of Accident Surgery, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr University Bochum, Germany1

Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Germany2

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum, Ruhr University Hospital Bochum, Germany3

Accident Surgery Hospital, Dresden Friedrichstadt Hospital, Dresden, Germany4

Department of Geriatrics and Early Rehabilitation, Marienhospital Herne, Ruhr University Hospital Bochum, Germany5

This content is open access.

Citation Information: Polish Journal of Surgery. Volume 79, Issue 2, Pages 98–105, ISSN (Print) 0032-373X, DOI: 10.2478/v10035-007-0016-8, September 2007

Publication History

Published Online:
2007-09-24

The Effect of Time-to-Surgery on Outcome in Elderly Patients with Proximal Femoral Fractures

There is a controversial debate about whether early surgical treatment of elderly patients with hip fractures yields health benefits.

Material and methods. In a prospective observational study of the care provided to hip fracture patients in Germany, the association between time-to-surgery and the frequency of postoperative complications and mortality was examined. The study was conducted between January 2002 and September 2003. We analyzed the data of patients aged 65 and older who underwent surgical treatment for isolated proximal femoral fractures (femoral neck fractures or pertrochanteric femoral fractures). The incidences of postoperative pneumonia, thrombosis or embolism, urinary tract infections, decubitus ulcers, and mortality (in-hospital mortality, one-year mortality) were compared in patients receiving early (≤ 24 h) and late (> 24 h) surgery.

Results. Clinical data on 2325 hip patients was available for analysis. The mean age of the study participants was 83.2±7.4; 80.3% of the patients were women. Comparison between patients with early (n=631) and late (n=1694) surgery did not show any statistically significant differences in the frequency of postoperative pneumonia, thrombosis/embolism or urinary tract infections (≤ 24 h vs > 24 h; 2.5% vs 3.9%, p=0.11; 0.79% vs 0.89%, p=0.83; 7.8% vs 9%, p=0.33). However, we did observe that fewer patients undergoing early surgery developed postoperative decubitus ulcers than those undergoing late surgery (1.9% vs 0.6%, p=0.02). A significant relationship between time-to-surgery and in-hospital mortality and/or one-year mortality could not be demonstrated statistically (≤ 24 h vs > 24 h; 3.3% vs 3.5%, p=0.80; 12.5% vs 13.8%, p=0.41).

Conclusions. In the present study, a statistically significant association between time-to-surgery and mortality could not be proven. Early surgical treatment, i.e. within 24 hours, significantly reduces the decubitus ulcer rate. This study confirms that elderly patients with femoral fractures in the hip region require surgical treatment within 24 hours.

Keywords: femoral fracture; complications

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