Surgery for hip fracture should be early when possible

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Rheumawire

Apr 19, 2004

Surgery for hip fracture should be early when possible

New York, NY - " Patients with hip fracture who are medically stable

should receive early surgery when possible, " say Dr Gretchen Orosz and

colleagues (Mount Sinai School of Medicine, New York, NY). When they

compared outcomes for a group of patients who underwent surgery within

24 hours of admission with a group who had surgery later, they found

that early surgery was consistently associated with less pain, a reduced

length of stay in the hospital, and probably fewer medical

complications.

However, there was no difference between the 2 groups in mortality or in

function, the researchers report in the April 14, 2004 issue of the

Journal of the American Medical Association [1].

Whether early surgery for hip fracture is beneficial is a long-running

controversy and is 1 of the most common clinical issues in the acute

management of these patients, the authors comment. Previous studies have

yielded conflicting results.

Orosz et al comment that their study is the largest to date to examine

hip-fracture outcomes both during the stay in the hospital and in the

following 6 months (during which time most recovery occurs). They

followed 1178 patients, of whom about one third had surgery within 24

hours of arriving at the hospital (398 patients, 33.8%). In this

early-surgery group, the median time to surgery was 19 hours, compared

with 40.6 hours in the late-surgery group.

Earlier surgery was not associated with improved mortality or improved

locomotion. (The overall unadjusted mortality was 8.2% at 2 months and

17.5% at 6 months.)

But patients who underwent surgery earlier rather than later had less

pain and a shorter stay in the hospital. Early surgery was associated

with lower pain scores (difference of -0.24 points on a 5-point scale)

and fewer days of severe or very severe pain during the first 5 days of

hospitalization (a difference of -0.22 to -0.30 days, or between 5 and 7

hours of severe pain). Also, the stay in the hospital was shortened by

1.94 days (p<0.001). These differences in pain and length of stay in the

hospital were accounted for by the delay in surgerypostoperative pain

and length of stay were similar in the 2 groups, the authors comment.

Overall, there was no difference in the rate of complications

experienced by the 2 groups. However, when the researchers considered

only those patients who were medically stable on admission, early

surgery was associated with fewer major complications (p=0.04).

" Early surgery should be a goal for most medically stable patients with

hip fracture, given that adverse effects are unlikely and that pain,

length of stay, and possibly complications will be reduced, " Orosz and

colleagues conclude.

It should be possible, they comment. In an earlier study [2], they found

that clinical issues (eg, waiting for test results or medical

stabilization) were infrequently cited as the reason for delaying

surgerythe problem was more likely to lie with the " system " (eg,

availability of surgeon or operating room). " Thus, it is feasible to

improve surgical timing that could in turn translate to improved

efficiency and reductions in severe pain, " they add.

Zosia Chustecka

Sources

1. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of

surgery for hip fracture and patient outcomes. JAMA 2004 Apr 14;

291(14):1738-43.

2. Orosz GM, Hannan EL, Magaziner J, et al. Hip fracture in the older

patient: reasons for delay in hospitalization and timing of surgical

repair. J Am Geriatr Soc 2002 Aug; 50(8):1336-40.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org