Theatre within 36 h for patients with fracture of the proximal femur: can we deliver?

Abstract

Proximal femur fractures carry significant levels of morbidity and mortality. Surgical delay is one factor that adversely affects outcome in these patients. In 2010, hospital-income from patients with proximal femur fractures was linked to the surgery being undertaken within 36h of admission. Can we deliver this target? Data from the 2009 National Hip Fracture Database was interrogated and appropriate patients were identified. Patient records were reviewed to identify the reasons for surgical delay. Mortality rates were compared within 36h and after. Five-hundred and thirty-two patients were admitted in 2009, 118 (22%) of them were delayed more than 36h. Surgery was delayed for a variety of identified reasons. Median time to surgery was 24h (1-273). Ninety-day mortality for patients treated within 36h was 12.4%, but 25% (P=0.047) in patients delayed for medical problems. Not all patients with a fracture of the proximal femur can have surgery within 36h of their injury. However, we have identified and describe four specific areas that could increase the number of patients who meet this target.