1039: DOES TIME TO SURGERY FOR TRAUMATIC HIP FRACTURE IMPACT THE EFFICACY OF FASCIA ILIACA BLOCKS?

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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Management of ongoing direct anticoagulant treatment in patients with hip fracture

Scientific Reports ◽

10.1038/s41598-021-89077-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Carlo Rostagno ◽

Alessandro Cartei ◽

Gianluca Polidori ◽

Roberto Civinini ◽

Alice Ceccofiglio ◽

...

Keyword(s):

Hip Fracture ◽

Demographic Data ◽

Drug Intake ◽

Control Group ◽

Complication Rates ◽

Adherence To Guidelines ◽

Time To Surgery ◽

Clinical Records ◽

Current Guidelines ◽

Type Of Fracture

AbstractAim of the present study was to investigate the effects of ongoing treatment with DOACs on time from trauma to surgery and on in-hospital clinical outcomes (blood losses, need for transfusion, mortality) in patients with hip fracture. Moreover we evaluated the adherence to current guidelines regarding the time from last drug intake and surgery. In this observational retrospective study clinical records of patients admitted for hip fracture from January 2016 to January 2019 were reviewed. 74 patients were in treatment with DOACs at hospital admission. Demographic data, comorbidities and functional status before trauma were retrieved. As control group we evaluated 206 patients not on anticoagulants matched for age, gender, type of fracture and ASA score. Time to surgery was significantly longer in patients treated with DOACs (3.6 + 2.7 vs. 2.15 ± 1.07 days, p < 0.0001) and treatment within 48 h was 47% vs. 80% in control group (p < 0.0001). The adherence to guidelines’ suggested time from last drug intake to surgery was 46%. Neither anticipation nor delay in surgery did result in increased mortality, length of stay or complication rates with the exception of larger perioperative blood loss (Hb levels < 8 g/dl) in DOACs patients (34% vs 9% p < 0.0001). Present results suggest that time to surgery is significantly longer in DOAC patients in comparison to controls and adherence to guidelines still limited.

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The impact of oral anticoagulation on time to surgery in patients hospitalized with hip fracture

Thrombosis Research ◽

10.1016/j.thromres.2015.09.017 ◽

2015 ◽

Vol 136 (5) ◽

pp. 962-965 ◽

Cited By ~ 42

Author(s):

Thomas Tran ◽

Aurélien Delluc ◽

Carine de Wit ◽

William Petrcich ◽

Grégoire Le Gal ◽

...

Keyword(s):

Hip Fracture ◽

Oral Anticoagulation ◽

Time To Surgery ◽

The Impact

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Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517722104 ◽

2017 ◽

Vol 8 (3) ◽

pp. 161-165 ◽

Cited By ~ 6

Author(s):

Alastair G. Dick ◽

Dominic Davenport ◽

Mohit Bansal ◽

Therese S. Burch ◽

Max R. Edwards

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

District General Hospital ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Retrospective Case ◽

Time To Surgery ◽

Surgery Mortality ◽

Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

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Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care

BMJ Open ◽

10.1136/bmjopen-2016-015574 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015574 ◽

Cited By ~ 12

Author(s):

Kristin Haugan ◽

Lars G Johnsen ◽

Trude Basso ◽

Olav A Foss

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Fast Track ◽

Conventional Care ◽

University Hospital ◽

Secondary Outcome ◽

Charlson Comorbidity Index Score ◽

Care Group ◽

Time To Surgery ◽

Significant Difference

ObjectiveTo compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.DesignRetrospective single-centre study.SettingUniversity hospital in middle Norway.Participants1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).Interventions788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013.Primary and secondary outcomePrimary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay.ResultsWe found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways.ConclusionsThere was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased.Trial registration numberNCT00667914; results

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Predictors of In-Hospital Ambulatory Status Following Low-Energy Hip Fracture Surgery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318814825 ◽

2019 ◽

Vol 10 ◽

pp. 215145931881482 ◽

Cited By ~ 2

Author(s):

Jordan C. Villa ◽

Joseph Koressel ◽

Jelle P. van der List ◽

Matthew Cohn ◽

David S. Wellman ◽

...

Keyword(s):

Peptic Ulcer ◽

Hip Fracture ◽

Peptic Ulcer Disease ◽

Median Time ◽

Low Energy ◽

Ulcer Disease ◽

Time To Surgery ◽

Ambulatory Status ◽

Delayed Time

Introduction: Twenty-five percent to seventy-five percent of independent patients do not walk independently after hip fracture (HF), and many patients experience functional loss. Early rehabilitation of functional status is associated with better long-term outcomes; however, predictors of early ambulation after HF have not been well described. Purposes: To assess the impact of perioperative and patient-specific variables on in-hospital ambulatory status following low-energy HF surgery. Methods: This is a retrospective analysis of 463 geriatric patients who required HF surgery at a metropolitan level-1 trauma center. The outcomes were time to transfer (out of bed to chair) and time to walk. Results: Three hundred ninety-two (84.7%) patients were able to transfer after surgery with a median time of 43.8 hours (quartile range: 24.7-53.69 hours), while 244 (52.7%) patients were able to walk with a median time of 50.86 hours (quartile range: 40.72-74.56 hours). Preinjury ambulators with aids (hazard ratio [HR]: 0.70, confidence interval [CI]: 0.50-0.99), age >80 years (HR: 0.66, CI: 0.52-0.84), peptic ulcer disease (HR: 0.57, CI: 0.57-0.82), depression (HR: 0.66, CI: 0.49- 0.89), time to surgery >24 hours (HR: 0.77, CI: 0.61-0.98), and surgery on Friday (HR: 0.73, CI: 0.56-0.95) were associated with delayed time to transfer. Delayed time to walk was observed in patients over 80 years old (HR: 0.74, CI: 0.56-0.98), females (HR: 0.67, CI: 0.48-0.94), peptic ulcer disease (HR: 0.23, CI: 0.84-0.66), and depression (HR: 0.51, CI: 0.33-0.77). Conclusions: Operative predictors of delayed time to transfer were surgery on Friday and time to surgery >24 hours after admission. Depression is associated with delayed time to transfer and time to walk. These data suggest that is important to perform surgeries within 24 hours of admission identify deficiencies in care during the weekends, and create rehabilitation programs specific for patient with depression. Improving functional rehabilitation after surgery may facilitate faster patient discharge, decrease inpatient care costs, and better long-term functional outcomes.

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Evaluating the efficacy of a two-site (‘COVID-19’ and ‘COVID-19-free’) trauma and orthopaedic service for the management of hip fractures during the COVID-19 pandemic in the UK

Bone & Joint Open ◽

10.1302/2633-1462.16.bjo-2020-0035.r1 ◽

2020 ◽

Vol 1 (6) ◽

pp. 190-197 ◽

Cited By ~ 4

Author(s):

Karen Chui ◽

Amit Thakrar ◽

Shivakumar Shankar

Keyword(s):

Hip Fracture ◽

Medical Patients ◽

Clinical Frailty Scale ◽

Time To Surgery ◽

Patient Demographics ◽

Trauma Service ◽

Free Model ◽

Bed Capacity ◽

The Uk ◽

Mean Time

Aims Hip fracture patients are at higher risk of severe COVID-19 illness, and admission into hospital puts them at further risk. We implemented a two-site orthopaedic trauma service, with ‘COVID’ and ‘COVID-free’ hubs, to deliver urgent and infection-controlled trauma care for hip fracture patients, while increasing bed capacity for medical patients during the COVID-19 pandemic. Methods A vacated private elective surgical centre was repurposed to facilitate a two-site, ‘COVID’ and ‘COVID-free’, hip fracture service. Patients were screened for COVID-19 infection and either kept at our ‘COVID’ site or transferred to our ‘COVID-free’ site. We collected data for 30 days on patient demographics, Clinical Frailty Scale (CFS), Nottingham Hip Fracture Scores (NHFS), time to surgery, COVID-19 status, mortality, and length of stay (LOS). Results In all, 47 hip fracture patients presented to our service: 12 were admitted to the ‘COVID’ site and 35 to the ‘COVID-free’ site. The ‘COVID’ site cohort were older (mean 86.8 vs 78.5 years, p = 0.0427) and with poorer CFS (p = 0.0147) and NHFS (p = 0.0023) scores. At the ‘COVID-free’ site, mean time to surgery was less (29.8 vs 52.8 hours, p = 0.0146), and mean LOS seemed shorter (8.7 vs 12.6 days, p = 0.0592). No patients tested positive for COVID-19 infection while at the ‘COVID-free’ site. We redirected 74% of our admissions from the base ‘COVID’ site and created 304 inpatient days’ capacity for medical COVID patients. Conclusion Acquisition of unused elective orthopaedic capacity from the private sector facilitated a two-site trauma service. Patients were treated expeditiously, while successfully achieving strict infection control. We achieved significant gains in medical bed capacity in response to the COVID-19 demand. The authors propose the repurposing of unused elective operating facilities for a two-site ‘COVID’ and ‘COVID-free’ model as a safe and effective way of managing hip fracture patients during the pandemic. Cite this article: Bone Joint Open 2020;1-6:190–197.

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An epidemiological study of the relationship between time to surgery and health status for elderly patients with a hip fracture

International Journal of Orthopaedic and Trauma Nursing ◽

10.1016/j.ijotn.2010.03.006 ◽

2010 ◽

Vol 14 (3) ◽

pp. 169-175 ◽

Cited By ~ 1

Author(s):

Carol Reid ◽

Glenn Gardner ◽

Carol Rooney ◽

Kylie-Ann Mallitt

Keyword(s):

Health Status ◽

Hip Fracture ◽

Elderly Patients ◽

Epidemiological Study ◽

Time To Surgery ◽

The Relationship

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The impact of time to surgery after hip fracture on mortality at 30- and 90-days: Does a single benchmark apply to all?

Injury ◽

10.1016/j.injury.2019.03.031 ◽

2019 ◽

Vol 50 (4) ◽

pp. 950-955 ◽

Cited By ~ 6

Author(s):

L.A. Beaupre ◽

H. Khong ◽

C. Smith ◽

S. Kang ◽

L. Evens ◽

...

Keyword(s):

Hip Fracture ◽

Time To Surgery ◽

The Impact

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Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures

Applied Sciences ◽

10.3390/app10238617 ◽

2020 ◽

Vol 10 (23) ◽

pp. 8617

Author(s):

Oana Suciu ◽

Bogdan Deleanu ◽

Horia Haragus ◽

Teodora Hoinoiu ◽

Cristina Tudoran ◽

...

Keyword(s):

Hip Fracture ◽

Platelet Aggregation ◽

Hip Fractures ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Platelet Aggregation Inhibitors ◽

Fragility Hip Fracture ◽

Time To Surgery ◽

Aggregation Inhibitors ◽

Antithrombotic Medication

Background: we aimed to analyze the influence of antithrombotic medication in delaying surgery for fragility hip fractures; Method: a total of 312 consecutive hip fracture cases over 55 years who underwent surgery in our Orthopedic Clinic; Results: of these, 90 patients received chronic antithrombotic medication. There were no differences between the medicated group and controls (n = 222) regarding age, gender, type of fracture and haemoglobin at admittance. However, median time to surgery was significantly longer in the medicated group: 4(3–6) days compared to 2(1–4) (p < 0.0001). By type of medication, time to surgery was: 3(1–4) days for acetylsalicylic acid (n = 44), 6(5.25–7.75) days for clopidogrel (n = 15), 4.5(4–7) days for acenocoumarin (n = 18) and 5(4–7.25) days for novel direct oral anticoagulants (n = 13). The Charlson comorbidity index was significantly higher in the medicated group: 5 [4–5] versus 4 [3–5]. There were no differences in transfusions except for fresh frozen plasma, which was administered more in the medicated patients; Conclusions: the prevalence of platelet aggregation inhibitors and anticoagulant use among fragility hip fracture patients is high, with almost a third using some form of antithrombotic medication. This may significantly lengthen time to surgery.

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