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Association of Timing of Surgery for Hip Fracture and Patient Outcomes
Gretchen M. Orosz, MD;
Jay Magaziner, PhD;
Edward L. Hannan, PhD;
R. Sean Morrison, MD;
Kenneth Koval, MD;
Marvin Gilbert, MD;
Maryann McLaughlin, MD;
Ethan A. Halm, MD, MPH;
Jason J. Wang, PhD;
Ann Litke, MA;
Stacey B. Silberzweig, MS, RD;
Albert L. Siu, MD, MSPH
JAMA. 2004;291:1738-1743.
Context Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes.
Objective To examine the association of timing of surgical repair of hip fracture with function and other outcomes.
Design Prospective cohort study including analyses matching cases of early ( 24 hours) and late (>24 hours) surgery with propensity scores and excluding patients who might not be candidates for early surgery.
Setting Four hospitals in the New York City metropolitan area.
Participants A total of 1206 patients aged 50 years or older admitted with hip fracture over 29 months, ending December 1999.
Main Outcome Measures Function (using the Functional Independence Measure), survival, pain, and length of stay (LOS).
Results Of the patients treated with surgery (n = 1178), 33.8% had surgery within 24 hours. Earlier surgery was not associated with improved mortality (hazard ratio, 0.75; 95% confidence interval [CI], 0.52-1.08) or improved locomotion (difference of –0.04 points; 95% CI, –0.49 to 0.39). Earlier surgery was associated with fewer days of severe and very severe pain (difference of –0.22 days; 95% CI, –0.41 to –0.03) and shorter LOS by 1.94 days (P<.001), but postoperative pain and LOS after surgery did not differ. Analyses with propensity scores yielded similar results. When the cohort included only patients who were medically stable at admission and therefore eligible for early surgery, the results were unchanged except that early surgery was associated with fewer major complications (odds ratio, 0.26; 95% CI, 0.07-0.95).
Conclusions Early surgery was not associated with improved function or mortality, but it was associated with reduced pain and LOS and probably major complications among patients medically stable at admission. Additional research is needed on whether functional outcomes may be improved. In the meantime, patients with hip fracture who are medically stable should receive early surgery when possible.
Author Affiliations: Department of Geriatrics (Drs Orosz, Morrison, and Siu, and Mss Litke and Silberzweig), Department of Orthopedics (Dr Gilbert), Department of Medicine (Drs McLaughlin and Halm), and Department of Health Policy (Dr Wang), Mount Sinai School of Medicine, New York, NY; Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore (Dr Magaziner); Department of Health Policy and Management, State University of New York, University at Albany School of Public Health (Dr Hannan); Department of Orthopedics, Hospital for Joint Diseases, New York, NY (Dr Koval); and Bronx VA Medical Center GRECC, Bronx, NY (Dr Siu).
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