Mortality effects of timing alternatives for hip fracture surgery.

Mortality effects of timing alternatives for hip fracture surgery. CMAJ. 2018 Aug 07;190(31):E923-E932 Authors: Sobolev B, Guy P, Sheehan KJ, Kuramoto L, Sutherland JM, Levy AR, Blair JA, Bohm E, Kim JD, Harvey EJ, Morin SN, Beaupre L, Dunbar M, Jaglal S, Waddell J, Canadian Collaborative Study of Hip Fractures Abstract BACKGROUND: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS: We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS: Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional ...
Source: cmaj - Category: General Medicine Authors: Tags: CMAJ Source Type: research