@article{ref1,
title="Factors associated with optimal patient outcomes after operative repair of isolated hip fractures in the elderly",
journal="Trauma surgery and acute care open",
year="2021",
author="deMeireles, Alirio J. and Gerhardinger, Laura and Oliphant, Bryant W. and Jenkins, Peter C. and Cain-Nielsen, Anne H. and Scott, John W. and Hemmila, Mark R. and Sangji, Naveen F.",
volume="5",
number="1",
pages="e000630-e000630",
abstract="BACKGROUND: Increased time to operative intervention is associated with a greater risk of mortality and complications in adults with a hip fracture. This study sought  to determine factors associated with timeliness of operation in elderly patients  presenting with an isolated hip fracture and the influence of surgical delay on  outcomes. <br><br>METHODS: Trauma quality collaborative data (July 2016 to June 2019) were  analyzed. Inclusion criteria were patients ≥65 years with an injury mechanism of  fall, Abbreviated Injury Scale (AIS) 2005 diagnosis of hip fracture, and AIS  extremity ≤3. Exclusion criteria included AIS in other body regions >1 and  non-operative management. We examined the association of demographic, hospital,  injury presentation, and comorbidity factors on a surgical delay >48 hours and  patient outcomes using multivariable regression analysis. <br><br>RESULTS: 10 182 patients  fit our study criteria out of 212 620 patients. Mean age was 82.7±8.6 years and  68.7% were female. Delay in operation >48 hours occurred in 965 (9.5%) of patients. Factors that significantly increased mortality or discharge to hospice were  increased age, male gender, emergency department hypotension, functionally dependent  health status (FDHS), advanced directive, liver disease, angina, and congestive  heart failure (CHF). Delay >48 hours was associated with increased mortality or  discharge to hospice (OR 1.52; 95% CI 1.13 to 2.06; p<0.01). Trauma center  verification level, admission service, and hip fracture volume were not associated  with mortality or discharge to hospice. Factors associated with operative delay  >48 hours were male gender, FDHS, CHF, chronic renal failure, and advanced  directive. Admission to the orthopedic surgery service was associated with less  incidence of delay >48 hours (OR 0.43; 95% CI 0.29 to 0.64; p<0.001). <br><br>DISCUSSION:  Hospital verification level, admission service, and patient volume did not impact  the outcome of mortality/discharge to hospice. Delay to operation >48 hours was  associated with increased mortality. The only measured modifiable characteristic  that reduced delay to operative intervention was admission to the orthopedic surgery  service. LEVEL OF EVIDENCE: III.<p /> <p>Language: en</p>",
language="en",
issn="2397-5776",
doi="10.1136/tsaco-2020-000630",
url="http://dx.doi.org/10.1136/tsaco-2020-000630"
}