Achieving hip fracture surgery within 36hours: an investigation of risk factors to surgical delay and recommendations for practice.

Adeel Aqil,Fahad Hossain,Harish Kapoor,Hassaan Sheikh,Joseph Aderinto,George Whitwell

doi:10.1007/s10195-015-0387-2

Adeel Aqil, Fahad Hossain + Show 4 more

Open Access

https://doi.org/10.1007/s10195-015-0387-2

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Abstract

BackgroundThe UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality.Materials and methodsProspectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated.ResultsA total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06–1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ2(1, N = 512) = 0.10, p = 0.757].ConclusionsHip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable.Level of evidenceIII

Highlights

A fracture of the hip is the commonest cause of injuryrelated death in the UK [1]
Materials and methods Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD)
Surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable

Summary

Introduction

A fracture of the hip is the commonest cause of injuryrelated death in the UK [1]. Prompt surgery has been associated with higher rates of independent living and lower 30-day and 1-year mortality rates [2,3,4,5]. In the context of hip fracture management, the BPT consists of an initial base tariff, with additional payments if further criteria of best practice have been met. One of these criteria is delivering hip fracture surgery within 36 h of presentation to a health care institution. This government target is in accordance with clinical. UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality.

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