Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay

Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( P = .0002) and 2.26 compared to the ASA 3 group ( P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.

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Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors

Medicine ◽

10.1097/md.0000000000006683 ◽

2017 ◽

Vol 96 (16) ◽

pp. e6683 ◽

Cited By ~ 9

Author(s):

Boris Sobolev ◽

Pierre Guy ◽

Katie J. Sheehan ◽

Eric Bohm ◽

Lauren Beaupre ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hospital Mortality ◽

Care Delivery ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Hypotension during hip fracture surgery and postoperative morbidity: a retrospective analysis

10.21203/rs.2.12877/v1 ◽

2019 ◽

Author(s):

Rachael Cusack ◽

Gabriel Beecham ◽

Grace Crilly ◽

Sebastian Vencken ◽

Donal Buggy

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Arterial Pressure ◽

Retrospective Analysis ◽

Postoperative Morbidity ◽

Hip Fracture Surgery ◽

Arterial Blood ◽

Intraoperative Hypotension ◽

Fracture Surgery ◽

Cumulative Time

Abstract Background: Hip fracture is a growing healthcare challenge, with 6-8% 30-day mortality and 20-30% of patients incurring major morbidity. Intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity. Objective: We evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity. Methods: A retrospective analysis was carried out on n=52 patients undergoing hip fracture surgery between January and June 2017. Electronic measurements of patients’ intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP < 75 mmHg, MAP < 55 mmHg, SAP ≤ 80% admission baseline, or SAP ≤ 80% pre-induction baseline). Univariate and bivariate descriptive statistics were generated for all relevant variables. With multivariable regression models containing known predictors, cumulative duration of hypotension was correlated with postoperative comorbidities as quantified by the Clavien-Dindo and Comprehensive Complication Indices. Results: Mean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia. Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP <80% pre-induction value adjusted to gender, age and the Charlson Comorbidity Index was associated with progression to a higher Clavien-Dindo classification (odds ratio: 1.020 per additional minute; 95% CI: 1.008 – 1.035; P = 0.003). Conclusions: In this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating active control of intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.

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