This Article Full Text Full Text (PDF) CME: Take the activities for this article: CME 3: July, August, September 2008 (publication date October 3, 2008; expi... Trauma Test 23: Fall 2008 (publication date November 14, 2008; expiration d... Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Google Scholar Articles by Al-Ani, A. N. Articles by Hedström, M. PubMed Articles by Al-Ani, A. N. Articles by Hedström, M. Related Collections Adult Trauma Social Bookmarking             What's this?

Early Operation on Patients with a Hip Fracture Improved the Ability to Return to Independent Living

A Prospective Study of 850 Patients

¹ Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Department of Orthopaedics, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. E-mail address for A.N. Al-Ani: amer.al-ani{at}karolinska.se
² Karolinska Institutet, Department of Orthopaedics, Danderyd Hospital, SE-182 88, Stockholm, Sweden
³ Karolinska Institutet, Department of Clinical Science and Education and Department of Orthopaedics, Capio S:t Göran Hospital, SE-112 81 Stockholm, Sweden
⁴ Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
⁵ Department of Public Health and Geriatrics, Clinical Nutrition and Metabolism Unit, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
Investigation performed at the Department of Orthopaedics, Karolinska University Hospital, Huddinge, and the Department of Orthopaedics, Danderyd University Hospital, Danderyd, Sweden

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Stockholm County Council Research Fund for clinical studies (EXPO 1999). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: We included 850 consecutive patients with a hip fracture who were admitted to the hospital during one year in a prospective study. Three cutoff limits for a comparison of early and late operation were defined. The outcome (the ability to return to independent living, risk for the development of pressure ulcers, length of the hospital stay, and mortality rate) for patients who had an operation within twenty-four, thirty-six, and forty-eight hours was compared with the outcome for those who had an operation at a later time.

Results: Patients who had the operation more than thirty-six and forty-eight hours after admission were less likely to return to independent living within four months (odds ratio, 0.44 and 0.33, respectively), whereas there was no significant difference with use of the twenty-four-hour cutoff limit. The incidence of pressure ulcers in the groups that had the operation later was increased at all three cutoff limits (a delay of more than twenty-four hours, more than thirty-six hours, and more than forty-eight hours) (odds ratio, 2.19, 3.42, and 4.34, respectively). The length of hospitalization was also increased in the groups that had the later operation (median, fourteen compared with eighteen days, fifteen compared with nineteen days, and fifteen compared with twenty-one days, respectively) (p < 0.001 for all comparisons). The importance of surgical timing remained significant after adjusting for several possible confounders (p < 0.05).

Conclusions: Early compared with late operative treatment of patients with a hip fracture is associated with an improved ability to return to independent living, a reduced risk for the development of pressure ulcers, and a shortened hospital stay.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.