Maximilian Peter Forssten (Örebro / SE), Ahmad Mohammad Ismail (Örebro / SE), Ioannis Ioannidis (Örebro / SE), Marcelo AF Ribeiro Jr (Abu Dhabi / AE), Yang Cao (Örebro / SE), Babak Sarani (Washington D.C. / US), Shahin Mohseni (Abu Dhabi / AE; Örebro / SE)
Introduction: As the number of hip fractures grows, this patient population will increasingly strain healthcare systems across the globe.
Objective: The aim was to determine if hip fracture patients who are frailer or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 hours.
Patients and Methods: All patients registered in the 2013-2021 National Trauma Data Bank who were ≥65 years old and underwent surgical fixation after suffering an isolated hip fracture due to a ground-level fall were considered for inclusion. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference (ARD) in in-hospital mortality.
Results: A total of 254,400 patients were included. After IPW, all potential confounders were balanced. A delay in hip fracture surgery was associated with an increased risk of in-hospital mortality across all strata; however, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 hours was associated with a 2.33 percentage point increase in the absolute mortality rate [adjusted ARD (95% CI): 2.33 (0.57-4.09), p = 0.010], resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 hours [adjusted ARD (95% CI): 4.65 (0.90-8.40), p = 0.015], resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the NNHs were 345 and 333, respectively.
Conclusion: Delaying surgery beyond 24 hours from admission increases the risk of mortality for all geriatric hip fracture patients; however, the magnitude of the negative impact increases with the patient's level of cardiac risk and frailty.
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