Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians’ guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to deter...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2008-03, Vol.55 (3), p.146-154
Main Authors: Shiga, Toshiya, Wajima, Zen’ichiro, Ohe, Yoko
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Biological and medical sciences
Cardiology
Confidence Intervals
Critical Care Medicine
Female
Fractures
Health Services Accessibility
Hip Fractures - mortality
Hip Fractures - surgery
Hip joint
Hospitalization
Humans
Intensive
Male
Medical sciences
Medicine
Medicine & Public Health
Models, Statistical
Mortality
Odds Ratio
Outcome Assessment (Health Care)
Pain Medicine
Pediatrics
Pneumology/Respiratory System
Reports Of Original Investigations
Time Factors
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Summary:Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians’ guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird random-effects model. Results: Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI=1.29–1.54, P
ISSN:0832-610X
1496-8975
DOI:10.1007/BF03016088