The sun should not set twice before hip fracture repair

“If all hip fracture surgeries were within two days of admission, one in six deaths among delayed surgeries would have been avoided,” says Dr. Boris Sobolev, leading author of a study recently published by the Canadian Medical Association Journal. The study compared various timing standards for surgical treatment of older adults with hip fracture who otherwise are medically stable. 

Using expertise in causal inference available at C2E2, health outcomes were compared for the same population of patients as if they were surgically-treated on different days after admission to hospital, without resorting to a randomized experiment. The authors project an additional 11 in-hospital deaths per 1,000 surgeries if hip fracture repair is performed after 3 inpatient days, rather than on the day of admission. 

“Surgery should take place on the day of admission or the following day", says Dr. Pierre Guy, a study co-lead. "The challenge is to ensure faster access to operating rooms and to resolve delays due to hospital transfers or late-day admissions."

Link: CMAJ