Abstract
Background
For geriatric hip fractures, the current American College of Surgeons guideline recommends
surgery within 48 hours. We sought to identify which factors delayed a patient’s progression
to definitive surgery at 2 associated level II trauma centers using chart abstraction.
Methods
We reviewed all geriatric patients who underwent a surgical procedure for a hip fracture.
Data regarding age, length of stay, procedure, and minutes from emergency department
arrival to operating room (OR) were evaluated. Chart abstraction determined if cardiac
or medical clearance and an echocardiogram were obtained. For patients that entered
the OR over 24 hours, a reason was identified for the delay. Analysis of variance
was used to compare continuous data, and chi-squared tests were used for categorical
data.
Results
Of 477 patients, 288 (60%) presented to the OR in under 24 hours, 114 (24%) between
24 and 36 hours, and 75 (16%) over 36 hours. There was a significant increase in length
of stay for patients, over 36 hours. Patients presenting to the OR between 24 and
36 hours were often delayed due to facility reasons such as OR or surgeon availability
while patients presenting over 36 hours were delayed due to medical comorbidities.
Of all patients in the under-24-hours group, 34.7% had an echocardiogram compared
with 56.1% and 69.3%, respectively. Similarly, 17.7% of patients received cardiac
clearance in the under-24-hours group, compared with 31.8% and 48%, respectively.
Conclusions
The timeliness of presentation of hip fractures to the OR is a multidisciplinary effort
and requires cooperation between a variety of services to increase safety and efficiency
as well as to control costs.
Keywords
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Article Info
Publication History
Published online: April 26, 2022
Accepted:
March 9,
2022
Received in revised form:
March 5,
2022
Received:
January 17,
2022
Identification
Copyright
© 2022 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.
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