Delayed surgery and general anesthesia were associated with worse outcomes.
At many hospitals, generalist physicians increasingly are joined by orthopedists in managing patients with hip fractures. In this study using the Veterans Affairs hospital database, researchers searched for factors that influenced short-term outcomes among 5683 men (mean age, 77) who were hospitalized for surgical repair of hip fracture.
Thirty-day mortality was 8%, and 21% of patients had complications such as pneumonia or urinary tract infections. In an analysis adjusted for many confounding variables, two modifiable perioperative factors predicted higher 30-day mortality — a delay of 4 or more days in performing surgery (odds ratio, 1.29) and use of general (vs. spinal or epidural) anesthesia (OR, 1.27). General anesthesia also was associated with higher risk for complications (OR, 1.33).
Comment: These findings confirm previous research, which suggested that delays in repairing hip fractures are associated with higher short-term morbidity or mortality. Not surprisingly, surgery was more likely to be performed within 3 days if the patient was admitted from Sunday through Wednesday (rather than on Thursday or Friday). The findings of higher short-term mortality in patients who received general anesthesia are consistent with at least one meta-analysis (Journal Watch Jan 19 2001). Unlike fixed demographic characteristics and comorbidities, surgical delays and choice of anesthesia can be modified, with potential reductions in morbidity and mortality rates.
Published in Journal Watch General Medicine January 15, 2008
Radcliff TA et al. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 2008 Jan; 90:34.