Adrien Delaveau1, Florian Saint-Genez2, Louis-Etienne Gayet2, Marc Paccalin3, Amine Ounajim4, Tanguy Vendeuvre5. 1. Service de Chirurgie Orthopédique et Traumatologie, CHU de Poitiers, 2, rue de la Milétrie, Poitiers, 86000 France. Electronic address: adriendelaveau@hotmail.fr. 2. Service de Chirurgie Orthopédique et Traumatologie, CHU de Poitiers, 2, rue de la Milétrie, Poitiers, 86000 France. 3. Service de Gériatrie, CHU de Poitiers, 2, rue de la Milétrie, Poitiers 86000 France. 4. Laboratoire PRISMATICS, CHU de Poitiers, 2, rue de la Milétrie, Poitiers 86000, France; Laboratoire de Mathématiques et Applications, Université de Poitiers, CNRS, UMR 7348, 11, boulevard Marie et Pierre Curie, Téléport 2 - BP 30179, Futuroscope de Poitiers-Chasseneuil Cedex, 86962, France. 5. Service de Chirurgie Orthopédique et Traumatologie, CHU de Poitiers, 2, rue de la Milétrie, Poitiers, 86000 France; Laboratoire PRISMATICS, CHU de Poitiers, 2, rue de la Milétrie, Poitiers 86000, France.
Abstract
INTRODUCTION: Treatment of hip fracture in the elderly is a major public health issue. Orthogeriatric departments have been developed for these patients at high risk of complications. Time to surgery seems to be an important factor in the care pathway, but remains controversial. OBJECTIVES: The aim of this study was to assess the impact of less than 24 hours' time to surgery on 1-year morbidity and mortality in patients managed in our orthogeriatric department. HYPOTHESIS: The study hypothesis was that<24 hours' time to surgery decreases mortality in elderly patients with upper femoral fracture. MATERIALS AND METHODS: A retrospective cohort study from September 2015 to July 2016 included patients aged 75 years and older, eligible for orthogeriatric management of upper femoral fracture. Patients with comorbidities were prioritized for admission and for access to the operating room. Time to surgery was defined as time between the arrival in A&E and transfer to the operating room. The primary endpoint was 1-year survival. Comorbidities were assessed on Charlson score. ROC curve analysis determined the optimal cut-off for time to surgery. Variables significantly associated with mortality were included in a Cox regression model to estimate the adjusted effect of time to surgery on mortality. RESULTS: One hundred and eight patients were included; mean age, 87±6.2 years; 26 male (24.1%), 82 female (75.9%). One-year mortality was 24.1% (26/108). Mean time to surgery was 14.1±30.9hours. ROC curve analysis showed a rise in mortality after a cut-off of 22hours 37minutes (p<0.0001). CONCLUSION: Within a dedicated orthogeriatric department, time to surgery is a significant factor in the management of hip fractures in the elderly. Patients should be prioritized for theater and ideally receive "early" surgery within 24hours of admission to A&E. The potential benefit of "ultra-early" surgery (time to surgery<6hours) requires robust assessment. LEVEL OF EVIDENCE: IV, Retrospective cohort study.
INTRODUCTION: Treatment of hip fracture in the elderly is a major public health issue. Orthogeriatric departments have been developed for these patients at high risk of complications. Time to surgery seems to be an important factor in the care pathway, but remains controversial. OBJECTIVES: The aim of this study was to assess the impact of less than 24 hours' time to surgery on 1-year morbidity and mortality in patients managed in our orthogeriatric department. HYPOTHESIS: The study hypothesis was that<24 hours' time to surgery decreases mortality in elderly patients with upper femoral fracture. MATERIALS AND METHODS: A retrospective cohort study from September 2015 to July 2016 included patients aged 75 years and older, eligible for orthogeriatric management of upper femoral fracture. Patients with comorbidities were prioritized for admission and for access to the operating room. Time to surgery was defined as time between the arrival in A&E and transfer to the operating room. The primary endpoint was 1-year survival. Comorbidities were assessed on Charlson score. ROC curve analysis determined the optimal cut-off for time to surgery. Variables significantly associated with mortality were included in a Cox regression model to estimate the adjusted effect of time to surgery on mortality. RESULTS: One hundred and eight patients were included; mean age, 87±6.2 years; 26 male (24.1%), 82 female (75.9%). One-year mortality was 24.1% (26/108). Mean time to surgery was 14.1±30.9hours. ROC curve analysis showed a rise in mortality after a cut-off of 22hours 37minutes (p<0.0001). CONCLUSION: Within a dedicated orthogeriatric department, time to surgery is a significant factor in the management of hip fractures in the elderly. Patients should be prioritized for theater and ideally receive "early" surgery within 24hours of admission to A&E. The potential benefit of "ultra-early" surgery (time to surgery<6hours) requires robust assessment. LEVEL OF EVIDENCE: IV, Retrospective cohort study.
Authors: Walter P Wodchis; Zeynep Or; Carl Rudolf Blankart; Femke Atsma; Nils Janlov; Yu Qing Bai; Anne Penneau; Mina Arvin; Hannah Knight; Kristen Riley; Jose F Figueroa; Irene Papanicolas Journal: Health Serv Res Date: 2021-09-06 Impact factor: 3.402