Allen Tanner Ii1, Stephanie Jarvis2, Alessandro Orlando2, Nnamdi Nwafo3, Robert Madayag4, Zachary Roberts5, Chad Corrigan6, Matthew Carrick7, Pamela Bourg4, Wade Smith3, David Bar-Or2,3. 1. Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA. 2. ION Research, 383 Corona St. #319, Denver, CO, 80218, USA. 3. Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA. 4. St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO, 80228, USA. 5. Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA. 6. Wesley Medical Center, 550 N. Hillside St. Wichita, KS, 67214, USA. 7. Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA.
Abstract
BACKGROUND: There are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost. METHODS: This was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost. RESULTS: There were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001. CONCLUSIONS: The results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs. LEVEL OF EVIDENCE: Level III.
BACKGROUND: There are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost. METHODS: This was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost. RESULTS: There were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001. CONCLUSIONS: The results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs. LEVEL OF EVIDENCE: Level III.
Keywords:
AAOS, American Academy of Orthopedic Surgeons; ACE, angiotensin-converting enzyme; AIS, Abbreviated Injury Scale; AOR, adjusted odds ratio; ASA, American Society of Anesthesiologists; AUC, area under the curve; CDC NDI, Centers for Disease Control National Death Index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; Geriatric hip fractures; HLOS, Hospital Length of Stay; IQR, interquartile range; Long-term mortality; OR, odds ratio; RR, respiratory rate; SBP, systolic blood pressure; SD, standard deviation; SE, standard error; TQIP, Trauma Quality Improvement Program; Time to surgery
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