In a recent British orthopaedic study, researchers found that mortality from hip fractures increased by 8% if operated on more than 24 hours after admission. The morality rate increased by 20% if operated on more than 48 hours after admission. Over 300,000 elderly people fracture hips each year. This study shows that, if possible, same day repair is best and improve chances of survival.
This has some serious implications. There is always natural preference for physiologically “optimizing” an older patient before surgery or for waiting until Monday to operate on an hip fracture that occurs on a Friday night, but these delays come with a risk. An unacceptable delay can result in a wrongful death.
The National Institute of Health and Clinical Excellence in Great Britain issues guidelines in 2011 for patients to be operated on the same day of or the day after hospital admission. The new report says earlier surgery can improve outcomes for elderly patients who are often frail and have multiple co-existing problems.
To the extent possible, earlier repair of hip fracture within 24 hours is better. It lessens the chance of complications from infection, from venous thrombosis, from respiratory compromise and other secondary illnesses. While the specific reason for increased mortality may vary with each patient, it is clear that survival for hip fracture repair is negatively correlated with time to treatment – the sooner the surgery, the lower the mortality rate. It’s something to remember should you find yourself in the emergency room late on a Friday night with an older relative with a hip fracture.