Abstract
BackgroundWhile the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.MethodsA cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.ResultsEarly surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.ConclusionsOlder age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.
Highlights
While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations
The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending in public hospitals in the Spanish National Health System and, secondly, we aim to explore factors associated with the decision to perform early hip fracture repair
The most common type of fracture was trochanteric (53%), surgical fixation was the most commonly employed repair technique (62%) and 24% of admissions occurred during weekends
Summary
While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, to explore factors associated with the decision to perform early hip fracture repair. The incidence of hip fracture in Spain is higher than 100 per 100,000 inhabitants-year, exceeding 500 per 100,000 in people aged 65 and over [1,2]. Mortality in the month following the fracture ranges from 5% to 10%, reaching 30% after a year [4,5,6], with another 30% of patients having a high. The non-surgical repair of hip fracture is uncommon because of unacceptable outcomes [10]. A decision on the surgical modality depends on the fracture itself and patient factors like age. Tromboembolic and antibiotic prophylaxis and early mobilization are accepted complementary treatments needed to get better outcomes [10]
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