Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery?
Introduction: This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery. Materials and Methods: Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2020-08-01
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| Series: | Geriatric Orthopaedic Surgery & Rehabilitation |
| Online Access: | https://doi.org/10.1177/2151459320946021 |
| _version_ | 1819276619864342528 |
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| author | Sanjit R. Konda MD Joseph R. Johnson ScB Erin A. Kelly MS Jeffrey Chan MD Thomas Lyon MD Kenneth A. Egol MD |
| author_facet | Sanjit R. Konda MD Joseph R. Johnson ScB Erin A. Kelly MS Jeffrey Chan MD Thomas Lyon MD Kenneth A. Egol MD |
| author_sort | Sanjit R. Konda MD |
| collection | DOAJ |
| description | Introduction: This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery. Materials and Methods: Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a single academic institution were included. Risk quartiles were constructed using Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) calculations. Negative binomial and multivariable logistic regression were used to evaluate time to surgery and delay to surgery, respectively. Pairwise comparisons were performed to evaluate 30-day mortality rates and demonstrate the effectiveness of the STTGMA tool in triaging mortality risk. Results: Six hundred eleven patients met inclusion criteria with mean age 81.1 ± 10.5 years. Injuries occurred mainly secondary to low-energy mechanisms (97.9%). Median time to surgery (31.9 hours overall) was significantly associated with STTGMA stratification ( P = .002). Moderate-risk patients had 33% longer ( P = .019) and high-risk patients had 28% longer time to surgery ( P = .041) compared to minimal risk patients. Delay to surgery (26.4% overall) was significantly associated with STTGMA stratification ( P = .015). Low-risk patients had 2.14× higher odds ( P = .009), moderate-risk patients had 2.70× higher odds ( P = .001), and high-risk patients had 2.18× higher odds of delay to surgery ( P = .009) compared to minimal risk patients. High-risk patients experienced higher 30-day mortality compared to minimal ( P < .001), low ( P = .046), and moderate-risk patients ( P = .046). Discussion: Patients in higher STTGMA quartiles encountered longer time to surgery, greater operative delays, and higher 30-day mortality. Conclusion: Score for Trauma Triage in the Geriatric and Middle-Aged can quickly identify hip fracture patients at risk for a delay to surgery and may allow treatment teams to optimize surgical timing by proactively targeting these patients. Level of Evidence: Prognostic Level III. |
| first_indexed | 2024-12-23T23:43:06Z |
| format | Article |
| id | doaj.art-6145304bea164415a7f2f464364a3755 |
| institution | Directory Open Access Journal |
| issn | 2151-4593 |
| language | English |
| last_indexed | 2024-12-23T23:43:06Z |
| publishDate | 2020-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Geriatric Orthopaedic Surgery & Rehabilitation |
| spelling | doaj.art-6145304bea164415a7f2f464364a37552022-12-21T17:25:35ZengSAGE PublishingGeriatric Orthopaedic Surgery & Rehabilitation2151-45932020-08-011110.1177/2151459320946021Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery?Sanjit R. Konda MD0Joseph R. Johnson ScB1Erin A. Kelly MS2Jeffrey Chan MD3Thomas Lyon MD4Kenneth A. Egol MD5 Jamaica Hospital Medical Center, Queens, NY, USA NYU Langone Orthopedic Hospital, NYU Langone Medical Center, NY, USA NYU Langone Orthopedic Hospital, NYU Langone Medical Center, NY, USA Jamaica Hospital Medical Center, Queens, NY, USA NYU Langone Hospital—Brooklyn, NY, USA Jamaica Hospital Medical Center, Queens, NY, USAIntroduction: This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery. Materials and Methods: Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a single academic institution were included. Risk quartiles were constructed using Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) calculations. Negative binomial and multivariable logistic regression were used to evaluate time to surgery and delay to surgery, respectively. Pairwise comparisons were performed to evaluate 30-day mortality rates and demonstrate the effectiveness of the STTGMA tool in triaging mortality risk. Results: Six hundred eleven patients met inclusion criteria with mean age 81.1 ± 10.5 years. Injuries occurred mainly secondary to low-energy mechanisms (97.9%). Median time to surgery (31.9 hours overall) was significantly associated with STTGMA stratification ( P = .002). Moderate-risk patients had 33% longer ( P = .019) and high-risk patients had 28% longer time to surgery ( P = .041) compared to minimal risk patients. Delay to surgery (26.4% overall) was significantly associated with STTGMA stratification ( P = .015). Low-risk patients had 2.14× higher odds ( P = .009), moderate-risk patients had 2.70× higher odds ( P = .001), and high-risk patients had 2.18× higher odds of delay to surgery ( P = .009) compared to minimal risk patients. High-risk patients experienced higher 30-day mortality compared to minimal ( P < .001), low ( P = .046), and moderate-risk patients ( P = .046). Discussion: Patients in higher STTGMA quartiles encountered longer time to surgery, greater operative delays, and higher 30-day mortality. Conclusion: Score for Trauma Triage in the Geriatric and Middle-Aged can quickly identify hip fracture patients at risk for a delay to surgery and may allow treatment teams to optimize surgical timing by proactively targeting these patients. Level of Evidence: Prognostic Level III.https://doi.org/10.1177/2151459320946021 |
| spellingShingle | Sanjit R. Konda MD Joseph R. Johnson ScB Erin A. Kelly MS Jeffrey Chan MD Thomas Lyon MD Kenneth A. Egol MD Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? Geriatric Orthopaedic Surgery & Rehabilitation |
| title | Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? |
| title_full | Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? |
| title_fullStr | Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? |
| title_full_unstemmed | Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? |
| title_short | Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery? |
| title_sort | can we accurately predict which geriatric and middle aged hip fracture patients will experience a delay to surgery |
| url | https://doi.org/10.1177/2151459320946021 |
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