Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk
IntroductionThe number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher ca...
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| Format: | Article |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1367457/full |
| _version_ | 1797269049927794688 |
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| author | Maximilian Peter Forssten Maximilian Peter Forssten Ahmad Mohammad Ismail Ahmad Mohammad Ismail Ioannis Ioannidis Ioannis Ioannidis Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Yang Cao Babak Sarani Shahin Mohseni Shahin Mohseni |
| author_facet | Maximilian Peter Forssten Maximilian Peter Forssten Ahmad Mohammad Ismail Ahmad Mohammad Ismail Ioannis Ioannidis Ioannis Ioannidis Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Yang Cao Babak Sarani Shahin Mohseni Shahin Mohseni |
| author_sort | Maximilian Peter Forssten |
| collection | DOAJ |
| description | IntroductionThe number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h.MethodsAll patients registered in the 2013–2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality.ResultsA total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57–4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90–8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively.ConclusionDelaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk. |
| first_indexed | 2024-04-25T01:42:12Z |
| format | Article |
| id | doaj.art-8301fd1b41ae4d2f98fe15ccdf8e3a7a |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-25T01:42:12Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-8301fd1b41ae4d2f98fe15ccdf8e3a7a2024-03-08T04:46:06ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2024-03-011110.3389/fsurg.2024.13674571367457Prioritizing patients for hip fracture surgery: the role of frailty and cardiac riskMaximilian Peter Forssten0Maximilian Peter Forssten1Ahmad Mohammad Ismail2Ahmad Mohammad Ismail3Ioannis Ioannidis4Ioannis Ioannidis5Marcelo A. F. Ribeiro6Marcelo A. F. Ribeiro7Marcelo A. F. Ribeiro8Yang Cao9Babak Sarani10Shahin Mohseni11Shahin Mohseni12Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, SwedenSchool of Medical Sciences, Orebro University, Orebro, SwedenDepartment of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, SwedenSchool of Medical Sciences, Orebro University, Orebro, SwedenDepartment of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, SwedenSchool of Medical Sciences, Orebro University, Orebro, SwedenPontifical Catholic University of São Paulo, São Paulo, BrazilKhalifa University and Gulf Medical University, Abu Dhabi, United Arab EmiratesDepartment of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesClinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, SwedenDivision of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, United StatesSchool of Medical Sciences, Orebro University, Orebro, SwedenDepartment of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesIntroductionThe number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h.MethodsAll patients registered in the 2013–2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality.ResultsA total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57–4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90–8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively.ConclusionDelaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.https://www.frontiersin.org/articles/10.3389/fsurg.2024.1367457/fullhip fracturefrailtycardiac risksurgical delaymortalitysurgical prioritization |
| spellingShingle | Maximilian Peter Forssten Maximilian Peter Forssten Ahmad Mohammad Ismail Ahmad Mohammad Ismail Ioannis Ioannidis Ioannis Ioannidis Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Marcelo A. F. Ribeiro Yang Cao Babak Sarani Shahin Mohseni Shahin Mohseni Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk Frontiers in Surgery hip fracture frailty cardiac risk surgical delay mortality surgical prioritization |
| title | Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk |
| title_full | Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk |
| title_fullStr | Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk |
| title_full_unstemmed | Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk |
| title_short | Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk |
| title_sort | prioritizing patients for hip fracture surgery the role of frailty and cardiac risk |
| topic | hip fracture frailty cardiac risk surgical delay mortality surgical prioritization |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1367457/full |
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