Adam M Lawless1, Siddarth Narula1, Peter D'Alessandro1, Christopher W Jones1, Hannah Seymour2, Piers J Yates1. 1. Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia. 2. Department of Geriatric Medicine, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia.
Abstract
BACKGROUND: Transfer time for patients with fractured hips is a significant problem in Australia. Current guidelines support operative management of hip fractures within 48 h with delays to surgery resulting in worse outcomes. The aim of study is to evaluate transfer times and delays and their effect on outcomes. METHODS: A total of 506 hip fractures undergoing surgical management were reviewed between 2017 and 2018 at a tertiary metropolitan hospital. We examined age, time to surgery, transfer time, delay to surgery, American Society of Anesthesiologists grading and 30-day and 1-year mortality. We directly compared outcomes between patients presenting initially to the tertiary hospital and those who were referred from a peripheral site requiring inter-hospital transfer. RESULTS: The mean time to surgery was 24.4 h. Ninety-five percent of patients received their emergency surgery within 48 h with inter-hospital transfer patients delayed on average only by 12.08 h when compared to primary presenters. Patients who received their surgery in more than 48 h had worse mortality outcomes. Inter-hospital transfer, regardless of time to surgery, was associated with increased mortality. CONCLUSION: Increased time to surgery was associated with increased mortality rates. Transfer delays from a peripheral hospital had a significant bearing on time to surgery. Transfer, regardless of time to surgery, is associated with increased mortality. Early transfer to a referral hospital or bypass of the peripheral hospital is recommended.
BACKGROUND: Transfer time for patients with fractured hips is a significant problem in Australia. Current guidelines support operative management of hip fractures within 48 h with delays to surgery resulting in worse outcomes. The aim of study is to evaluate transfer times and delays and their effect on outcomes. METHODS: A total of 506 hip fractures undergoing surgical management were reviewed between 2017 and 2018 at a tertiary metropolitan hospital. We examined age, time to surgery, transfer time, delay to surgery, American Society of Anesthesiologists grading and 30-day and 1-year mortality. We directly compared outcomes between patients presenting initially to the tertiary hospital and those who were referred from a peripheral site requiring inter-hospital transfer. RESULTS: The mean time to surgery was 24.4 h. Ninety-five percent of patients received their emergency surgery within 48 h with inter-hospital transfer patients delayed on average only by 12.08 h when compared to primary presenters. Patients who received their surgery in more than 48 h had worse mortality outcomes. Inter-hospital transfer, regardless of time to surgery, was associated with increased mortality. CONCLUSION: Increased time to surgery was associated with increased mortality rates. Transfer delays from a peripheral hospital had a significant bearing on time to surgery. Transfer, regardless of time to surgery, is associated with increased mortality. Early transfer to a referral hospital or bypass of the peripheral hospital is recommended.