1. Potera, Carol


Early surgery found to reduce life-threatening complications.


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For elderly patients with hip fracture, surgery within 24 hours is best for preventing infections and life-threatening complications. Among patients at 72 hospitals in Ontario, Canada, of the 13,731 with hip fractures who did not receive surgery within 24 hours, 6.5% died within a month, compared with 5.8% of the 13,731 matched patients who received surgery quickly. Patients who had hip surgery within 24 hours also had lower rates of life-threatening complications such as heart attacks, pulmonary embolism, and pneumonia.

Figure. Hip X-ray, s... - Click to enlarge in new window Hip X-ray, showing repair of a fracture. Photo (C)

The study tracked patients who underwent hip fracture surgery between April 2009 and March 2014. The mean time to surgery was 38.8 hours, the mean age was 80 years, and 71% of patients were women. "This is the first study, to our knowledge, to analyze time as a continuous variable in hours and empirically identify a time-to-surgery threshold associated with increased complications after hip fracture," the researchers said.


Few guidelines exist for timing hip fracture surgery. Current guidelines in Canada and the United States recommend surgery for hip fracture within 48 hours. This allows physicians to run laboratory tests on elderly patients, which they assume will insure a safer surgery.


Comanagement teams that include orthopedic surgeons, geriatricians, and other specialists offer a possible solution to reduce time to surgery as well as postsurgical hospital stays. Also, more efficient preoperative evaluation and stabilization of patients, and flexibility of scheduling surgeries, ideally within 24 hours, may improve care for hip fracture patients and prevent life-threatening complications.-Carol Potera




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