Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment
Introduction: Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversial...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-10-01
|
| Series: | Journal of Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4426/13/10/1470 |
| _version_ | 1797573293664894976 |
|---|---|
| author | Alina Daginnus Jan Schmitt Jan Adriaan Graw Christian Soost Rene Burchard |
| author_facet | Alina Daginnus Jan Schmitt Jan Adriaan Graw Christian Soost Rene Burchard |
| author_sort | Alina Daginnus |
| collection | DOAJ |
| description | Introduction: Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is “time-to-surgery”. The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. Materials and Methods: All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (<i>n</i> = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Results: Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, <i>p</i> = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, <i>p</i> = 0.567). Conclusions: The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type. |
| first_indexed | 2024-03-10T21:07:46Z |
| format | Article |
| id | doaj.art-44208ac0768d4f0b99f4fe88e8b4949c |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-10T21:07:46Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-44208ac0768d4f0b99f4fe88e8b4949c2023-11-19T17:02:05ZengMDPI AGJournal of Personalized Medicine2075-44262023-10-011310147010.3390/jpm13101470Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its TreatmentAlina Daginnus0Jan Schmitt1Jan Adriaan Graw2Christian Soost3Rene Burchard4Faculty of Medicine, University of Marburg, 35037 Marburg, GermanyFaculty of Medicine, University of Marburg, 35037 Marburg, GermanyDepartment of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, 89070 Ulm, GermanyInstitute for Empirics & Statistics, FOM University of Applied Sciences, 45141 Essen, GermanyFaculty of Medicine, University of Marburg, 35037 Marburg, GermanyIntroduction: Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is “time-to-surgery”. The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. Materials and Methods: All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (<i>n</i> = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Results: Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, <i>p</i> = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, <i>p</i> = 0.567). Conclusions: The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type.https://www.mdpi.com/2075-4426/13/10/1470hip fracturetime to surgerycomplicationsintracapsular hip fractureextracapsular hip fracture |
| spellingShingle | Alina Daginnus Jan Schmitt Jan Adriaan Graw Christian Soost Rene Burchard Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment Journal of Personalized Medicine hip fracture time to surgery complications intracapsular hip fracture extracapsular hip fracture |
| title | Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment |
| title_full | Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment |
| title_fullStr | Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment |
| title_full_unstemmed | Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment |
| title_short | Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment |
| title_sort | rate of complications after hip fractures caused by prolonged time to surgery depends on the patient s individual type of fracture and its treatment |
| topic | hip fracture time to surgery complications intracapsular hip fracture extracapsular hip fracture |
| url | https://www.mdpi.com/2075-4426/13/10/1470 |
| work_keys_str_mv | AT alinadaginnus rateofcomplicationsafterhipfracturescausedbyprolongedtimetosurgerydependsonthepatientsindividualtypeoffractureanditstreatment AT janschmitt rateofcomplicationsafterhipfracturescausedbyprolongedtimetosurgerydependsonthepatientsindividualtypeoffractureanditstreatment AT janadriaangraw rateofcomplicationsafterhipfracturescausedbyprolongedtimetosurgerydependsonthepatientsindividualtypeoffractureanditstreatment AT christiansoost rateofcomplicationsafterhipfracturescausedbyprolongedtimetosurgerydependsonthepatientsindividualtypeoffractureanditstreatment AT reneburchard rateofcomplicationsafterhipfracturescausedbyprolongedtimetosurgerydependsonthepatientsindividualtypeoffractureanditstreatment |