DOS Kongressen 2014 ·
143
Surgical delay increases early mortality for patients
with proximal femoral fractures. A study from The
Danish Fracture Database Collaborators.
Anne Marie Nyholm, KIrill Gromov, Henrik Palm, Michael Brix,
Thomas Kallemose, Anders Troelsen
Department of Orthopaedics, Hvidovre Hospital
Background:
Surgical delay (SD) of proximal femoral fracture (PFF) is of inter-
est as some studies show SD >24 or >48 hours to significantly increase mortal-
ity (MT), while others find no correlation.
Purpose / Aim of Study:
To show if a) SD or b) surgeon’s experience (SE)
increases MT rates for following PFF.
Materials and Methods:
We included trochanteric or femoral neck fractures
(AO31A and 31B) from the Danish Fracture Database, excluding pathological
and high-energy trauma fractures. Data included age, gender, American Society
of Anesthesiologists (ASA) score, type of fracture and osteosynthesis, SE and
SD. SE was defined as “attending or above” or “below attending”. SD was defined
as hours (h) from radiological diagnostics until start of surgery. MT data was
from The Civil Registration System. Multiple logistical regression analysis was
used to calculate MT rates.
Findings / Results:
3595 fractures were included: mean age 81.0 years, 70%
were female and 49% were trochanteric fractures (AO31A). SD was <12h in
21%, <24h in 70%, <48h in 92% and <72h in 95% of cases. SE was “Attending
or above” in 49% of all cases. MT was 10.8% at day 30 and 17.4% at day 90.
SD >12h increased adjusted risk of 30-day MT (OR 1.43, p=0.02). SD >24h
increased adjusted risk of 90-day MT (OR 1.24, p=0.03). SE “below attend-
ing” increased MT risk at both day 30 (OR 1.27, p=0.04) and day 90 (OR 1.28,
p=0.01). Increasing age and ASA score, male gender and type of osteosynthesis
significantly increased both 30-day and 90-day MT.
Conclusions:
In this study SD >12 h and SD >24 h significantly increased ad-
justed risk of MT at day 30 and day 90, respectively. The adjusted risk of both
30-day MT and 90-day mortality increased significantly when SE was “below
attending”. The study findings challenge the departments to facilitate fast surgi-
cal treatment supported by attending orthopaedic surgeons.
90.
