Factors that delay surgery in hip fracture and outcomes in elderly adults. Cohort study
Abstract
Introduction: Hip fracture is an important cause of morbidity, functional impairment, and mortality in older adults. A longer waiting time until surgical management affects patient survival and quality of life. Consequently, our objective was to describe the factors associated with surgical delay and to evaluate the quality of life and mortality at 3 months in patients undergoing surgery for proximal femur fracture.
Methods: This is a prospective cohort study. The medical and administrative causes of surgical delay were evaluated. Sociodemographic and clinical surveys were also collected. Quality of life was evaluated using the validated instrument EQ-5D-5L. Patients were followed- up for 30 and 90 days after surgery. Descriptive statistics and the Wilcoxon test were used to contrast outcomes. ClinicalTrials.gov identifier: NCT04217642.
Results: One hundred and thirty thousand patients were included with a mean age of 78.9 years (SD 14.9). The majority of them had ASA II classification (53.1 %) and an average Charlson index of 4.7 (SD 1.9). In 76.2 % of cases, the fracture was caused by a fall from the height itself. The average time from admission to definitive surgical management was 8.5 days (SD 5.1), which increased the risk of death by 6.9 % (p=0.008). EPS delay in the authorization to perform the surgery, the medical events generated during admission, the request for evaluation by additional medical specialties, and gender were associated in a significant way with a delay time of 4.65, 3.29, 3.08, and 2.13 days, respectively. The quality of life (EQ-5D-5L index) at admission was, on average, 0.137, with a tendency towards an increase at 30 (0.464) and 90 days (0.586). Mortality was reported in six patients (6.2 %) at 90 days of follow-up.
Conclusions: The main factors related to surgical delay were administrative, such as authorization for surgery. At 3 months follow-up, the quality of life improved considerably compared to the pre-surgical assessment, and there was low mortality in the studied population.
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References
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