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The Journal of Bone and Joint Surgery, Vol 77, Issue 10 1551-1556, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip
JD Zuckerman, ML Skovron, KJ Koval, G Aharonoff and VH Frankel
Geriatric Hip Fracture Research Group, Hospital for Joint Diseases, New York, NY 10003, USA.
We prospectively studied 367 patients who had a fracture of the hip, to
determine the effect of an operative delay on postoperative complications
and on the one-year mortality rate. All of the patients were at least
sixty-five years old, cognitively intact, living at home, and able to walk
before the fracture. An operative delay was defined as an interval of three
calendar days or more between the time of admission to the hospital and the
operation. The operation was performed within two calendar days after
admission in 267 (73 per cent) of the patients. When the factors of the
patient's age and sex and the number of pre-existing medical conditions
were controlled, it was found that an operative delay beyond this period
approximately doubled the risk of the patient dying before the end of the
first postoperative year. When the patient's age and sex and the severity
of pre-existing medical conditions were controlled, there was also an
increase in mortality associated with an operative delay, although this was
not significant. With the numbers studied, an operative delay beyond two
calendar days did not have a significant effect on the prevalence of
complications during hospitalization. We concluded that an operative delay
of more than two calendar days after admission is an important predictor of
mortality within one year for elderly patients who have a fracture of the
hip and who are cognitively intact, able to walk, and living at home before
the fracture. Optimally, such patients should have the operation within two
calendar days after admission to the hospital.
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