Carsten Schoeneberg1, Rene Aigner2, Bastian Pass3, Ruth Volland4, Daphne Eschbach5, Shugirthanan Edwin Peiris6, Steffen Ruchholtz7, Sven Lendemans8. 1. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: carsten.schoeneberg@krupp-krankenhaus.de. 2. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: aignerr@med.uni-marburg.de. 3. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: bastian.pass@krupp-krankenhaus.de. 4. AUC, Akademie der Unfallchirurgie GmbH, Munich, Germany. Electronic address: ruth.volland@auc-online.de. 5. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: eschbach@med.uni-marburg.de. 6. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: edwin.peiris@krupp-krankenhaus.de. 7. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: ruchholt@med.uni-marburg.de. 8. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: sven.lendemans@krupp-krankenhaus.de.
Abstract
BACKGROUND: Time-to-surgery in geriatric hip fractures remains of interest. The majority of the literature reports a significantly decreased mortality rate after early surgery. Nevertheless, there are some studies presenting no effect of time-to-surgery on mortality. The body of literature addressing the effect of an orthogeriatric co-management is growing. Here we investigate the effect of time-to-surgery on in-house mortality in a group of patients treated under the best possible conditions in certified orthogeriatric treatment units. METHODS: We conducted a retrospective cohort registry analysis from prospectively collected data of the AltersTraumaRegister DGU®. Data were analyzed univariably, and the association of early surgery with in-house mortality was assessed with multivariable logistic regression while controlling for specified patient characteristics. Additionally, propensity score matching for time-to-surgery was applied to examine its effect on the in-house mortality rate. FINDINGS: A total of 15,099 patients met the inclusion criteria. The median age was 85 years (IQR 80-89), and 72.1% were female. The overall in-house mortality rate was 5.5%. Most (71.2%) of the patients were treated within 24 h, and 91.6% within 48 h. Neither the multivariable logistic regression model nor the propensity score matching indicated that early surgery was associated with a decreased mortality rate. The most important indicators for mortality were ASA ≥ 3 [Odds ratio (OR) 3.4, 95% confidence interval (CI) 2.35-5.11], fracture event during inpatient stay (OR 2.6, 95% CI 1.48-4.3), ISAR ≥ 2 (OR 1.88, 95% CI 1.33-2.76), and male gender (OR 1.71, 95% CI 1.39-2.09). INTERPRETATION: Our results suggest that for those patients, who were treated in an orthogeriatric co-management under the best possible conditions, there are no significant differences regarding in-house mortality rate between the time-to-surgery intervals of 24 and 48 h or slightly above. This and the comparatively small number of patients who underwent surgery after 24 h show that an extension of the pre-surgery interval, justified by an orthogeriatric treatment team, will not be detrimental to the affected patients.
BACKGROUND: Time-to-surgery in geriatric hip fractures remains of interest. The majority of the literature reports a significantly decreased mortality rate after early surgery. Nevertheless, there are some studies presenting no effect of time-to-surgery on mortality. The body of literature addressing the effect of an orthogeriatric co-management is growing. Here we investigate the effect of time-to-surgery on in-house mortality in a group of patients treated under the best possible conditions in certified orthogeriatric treatment units. METHODS: We conducted a retrospective cohort registry analysis from prospectively collected data of the AltersTraumaRegister DGU®. Data were analyzed univariably, and the association of early surgery with in-house mortality was assessed with multivariable logistic regression while controlling for specified patient characteristics. Additionally, propensity score matching for time-to-surgery was applied to examine its effect on the in-house mortality rate. FINDINGS: A total of 15,099 patients met the inclusion criteria. The median age was 85 years (IQR 80-89), and 72.1% were female. The overall in-house mortality rate was 5.5%. Most (71.2%) of the patients were treated within 24 h, and 91.6% within 48 h. Neither the multivariable logistic regression model nor the propensity score matching indicated that early surgery was associated with a decreased mortality rate. The most important indicators for mortality were ASA ≥ 3 [Odds ratio (OR) 3.4, 95% confidence interval (CI) 2.35-5.11], fracture event during inpatient stay (OR 2.6, 95% CI 1.48-4.3), ISAR ≥ 2 (OR 1.88, 95% CI 1.33-2.76), and male gender (OR 1.71, 95% CI 1.39-2.09). INTERPRETATION: Our results suggest that for those patients, who were treated in an orthogeriatric co-management under the best possible conditions, there are no significant differences regarding in-house mortality rate between the time-to-surgery intervals of 24 and 48 h or slightly above. This and the comparatively small number of patients who underwent surgery after 24 h show that an extension of the pre-surgery interval, justified by an orthogeriatric treatment team, will not be detrimental to the affected patients.
Authors: Alessandro De Luca; Luigi Murena; Michela Zanetti; Paolo De Colle; Chiara Ratti; Gianluca Canton Journal: Arch Orthop Trauma Surg Date: 2022-07-05 Impact factor: 3.067
Authors: Markus Laubach; Felix M Bläsius; Ruth Volland; Matthias Knobe; Christian D Weber; Frank Hildebrand; Miguel Pishnamaz Journal: Eur J Trauma Emerg Surg Date: 2021-10-05 Impact factor: 2.374