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Causes and Effects of Delays in Surgery for Hip Fracture FREE

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The full report is titled “Causes and Effects of Surgical Delay in Patients With Hip Fracture. A Cohort Study.” It is in the 16 August 2011 issue of Annals of Internal Medicine (volume 155, pages 226-233). The authors are M.T. Vidán, E. Sánchez, Y. Gracia, E. Marañón, J. Vaquero, and J.A. Serra.

Ann Intern Med. 2011;155(4):I-23. doi:10.7326/0003-4819-155-4-201108160-00001
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What is the problem and what is known about it so far?

Most doctors believe that a patient with a hip fracture should be operated on as soon as possible and preferably within 24 hours. However, the evidence on whether early surgery produces better outcomes is conflicting: Some studies support this belief, but others do not.

Why did the researchers do this particular study?

Many previous studies have not acknowledged that surgery is often delayed because patients have acute medical problems and that patients with these problems have bad outcomes regardless of when surgery is done. The researchers reasoned that delayed surgery might be associated with bad outcomes because acute medical problems cause both delays and bad outcomes, not because the delays themselves cause bad outcomes.

Who was studied?

2250 consecutive patients admitted to the hip fracture unit of a hospital in Madrid, Spain.

How was the study done?

For each patient, the researchers counted the number of acute medical conditions on admission, measured the time from admission to surgery, determined the reasons for any delays, noted deaths during hospitalization, and determined how many complications occurred.

What did the researchers find?

Four percent of patients died, and 46% had a complication. Two thirds of the patients waited 48 or more hours for surgery, usually because operating rooms were not available or the patient had an acute medical condition. Longer delays were associated with higher death rates and more complications, but when the researchers adjusted their results for acute medical conditions, these associations became very small and may not really exist. The exception was the association between longer delays to surgery and urinary tract infections, which remained after adjustment.

What were the limitations of the study?

It is difficult to detect bias in observational studies, such as this one.

What are the implications of the study?

Early surgery may be a better choice for patients with hip fracture and no acute medical conditions, but the optimal time for surgery in patients with acute medical conditions remains to be determined.





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