Hip fracture surgery within 48 hours – a reachable recommendation?

Abstract

Introduction The usual treatment for all types of hip fracture is surgical. Conservative treatment is rarely indicated in developed countries. It is recognized that treatment decreases morbidity and mortality, controls pain and promotes early mobilization. The complexity of most fragility fracture patients is compound by comorbidities and polypharmacy, and requires a multidisciplinary approach. There exists a vast number of available guidelines that vary in relevance and quality. However, evidence supports that hip fracture surgery within 48 hours of admission is associated with better outcomes. Materials and methods We retrospectively reviewed the cases operated for proximal femoral fracture in 2014, at our institution. We intend to evaluate: age, sex, fracture classification, comorbidities, length of hospital stay and average waiting time for surgery. Results We evaluated 474 patients (average 1.298 per day), with an average age of 71 (23–98). Seventy-seven percent are female and 63% of the fractures are extracapsular. The mean time of hospitalization are 18 days and the mean time of waiting for surgery is greater than 5 days. Only 26% of surgeries were done within 48 hours of admission. Discussion The number of these types of fractures has increased. Timing of surgery is one of the biggest challenges of the health system. It involves the pre-hospital emergency coordination, trauma services, geriatrics, anesthesia and surgical equipment capacity. Conclusion Hip fracture is a real worldwide health issue, which increases with age and occurs principally in women. Ideally, it should perform surgery on the day, or the day after, admission. It is essential to identify and treat correctable comorbidities immediately so that surgery is not delayed. For this reason, their approach should be multidisciplinary, including orthogeriatric and trauma teams.