Survival After Hip Fracture Surgery May Depend On How Busy The Hospital Is

Patients with hip fracture who are admitted to the hospital during a busy time may experience delayed surgery and have a higher risk for 60-day mortality, a study discovered.

“When the operating room is busy, 20% more of the patients die within 60 days after the operation,” said study author Professor Johan Håkon Bjørngaard, of the Norwegian University of Science and Technology’s (NTNU) Department of Public Health and Nursing, in a press release.

The researchers assessed time to surgery and 60-day post-admission mortality among patients aged ≥70 years admitted to the hospital for acute hip fracture surgery between 2008 and 2016. The exposure was the proportion of hospital capacity occupied by newly admitted surgical patients. Patients admitted when the proportion of newly admitted patients was high were compared to patients admitted to the same hospital when admissions were lower; patients admitted during the same month on similar weekdays, and at similar times of day were compared.

Final analysis included 60,072 patients. the mean age was 84.6 years (standard deviation, 6.8 years), and the majority of patients were female (78%). The median time to surgery was 20 hours (interquartile range, 11-29 hours). The 60-day mortality rate was 14%.

Patients admitted during a period of high rates of new surgical admissions, compared to those in the low group, had a 20% longer time to surgery (95% confidence interval [CI], 16-25%) and 20% higher rate of 60-day mortality (hazard ratio, 1.2; 95% CI, 1.1-1.4).

“We found that surgery was delayed in hip fracture patients who were admitted during periods of high volumes of acute surgical admissions. This finding may indicate that hip fracture patients were not prioritized during periods of high activity. The association between high-volume recent acute surgical admissions and longer time to surgery was somewhat attenuated, but still evident after excluding orthopaedic surgery or procedures related to the digestive system from the exposure,” the researchers wrote.

Study author and orthopedist Lars Gunnar Johnsen elaborated that prioritizing patients “is part of a discussion about organizing emergency surgery. This could mean that we need to screen surgery hip fracture patients more than what’s currently being done.”

The study was published in The Bone & Joint Journal.