Hip fracture? Do not delay surgery experts warn

Reduce death after hip surgery in medically stable older patients by doing surgery on the day of admission or the following day, according to a large study published in the Canadian Medical Association Journal.

About 30 000 older adults are admitted to hospital in Canada each year with hip fracture. They are at increased risk of death, with about 5% of women and 10% of men dying within 30 days. So health ministers set 48 hours from admission as a standard for 90% of hip fracture surgeries. Some research suggests an optimal window of 24 hours.

“Our study was concerned with effects of possible changes in policy for the timing of surgery on mortality in the population of patients with hip fracture in Canada,” says lead author, Prof. Boris Sobolev, School of Population and Public Health, the University of British Columbia, Vancouver, BC.

Teams from the UK, Canada and the US looked at data from nearly 140 000 people aged 65 years or older who had surgery for a first-time hip fracture at 144 hospitals (74% were women and almost half were older than 85 years).

The authors asked how postoperative death rates would change if the same patients had surgery on the day of admission, day two, day three, or after day three. They project an additional 11 deaths for every 1,000 hip fracture surgeries if all surgeries in medically stable patients were done after inpatient day three instead of on admission day.

“Our findings allow us to infer a critical point for the timing of hip fracture repair,” says Dr Pierre Guy, principal investigator. “We suggest that clinicians, administrators, and policy-makers ‘not let the sun set twice’ on medically stable older adults before their hip fracture repair.”

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