Surgery within 24 hours reduces mortality in patients with hip fractures: Study

In a recent study conducted by Welford A et. al, the researchers aimed to evaluate the effect of time on surgical intervention from admission on mortality and morbidity for patients with hip fractures.

The researchers searched a total of 46 studies including MEDLINE and Embase papers from the beginning (January 1991) to June 2020 and a few manually evaluated reference lists to find more papers. In total, they assessed 521,857 hip fractures with 64,047 postoperative deaths. In their primary comparative research studies, they selected patients aged over 60 years, with surgically treated non-pathological primary proximal femoral fractures.

Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days and randomized controlled trials were excluded.

Also, two authors collected data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality, while the secondary outcomes were complications and mortality at other time points.

The findings of the study are as follows:

· In a pooled analysis of 15 studies, the relative risk of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86

· The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates.

· In a pooled analysis of six studies, the Relative risk of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87.

Thus, the researchers concluded that it is reduced mortality for patients operated within 24 hours as compared to those operated on beyond 24 hours or within 24 to 36 hours. Additionally, where resources allow and there is no specific reversible contraindication to early surgery, they strongly advised that hip fractures should be surgically treated within 24 hours.

Reference:

A study titled, "The association between surgical fixation of hip fractures within 24 hours and mortality: a systematic review and a meta-analysis" by Welford Paul published in The Bone and Joint Journal.

https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2582.R1