Predictors of surgery delay for hip fracture

Background Recent guidelines recommend early surgical treatment of hip fractures in the elderly. Understanding the factors that delay surgical intervention is essential in order to facilitate early treatment. The aim of the present study is to determine the factors delaying surgical treatment of hip fractures in elderly patients for more than 2 days. Methods Assessment of hospital discharge records and chart review of 1733 consecutive patients undergoing surgery for hip fractures between 2004-2007 at the two Italian wards of Sant�Orsola-Malpighi Hospital, Bologna (N=1286) and S. Maria della Scaletta Hospital, Imola (N=447). Logistic regression models were used to examine potential predictors of surgery delay including gender, age, ward, comorbidity, type of intervention (partial or total hip replacement, reduction and internal fixation), International Normalized Ratio (INR), Haemoglobin (Hb), American Society of Anaesthesiologists (ASA) score, and day of admission (categorized as Monday to Wednesday, Thurday-Friday, Saturday-Sunday). Results 923 (53.3%) patients were operated within 2 days of admission to the hospital. Age, arrhythmia, type of intervention (partial or total hip replacement), INR score>1.5 and an ASA score of 4 compared to 1-2, admission on Thurdays-Friday or Saturday-Sunday and ward significantly predicted a surgery delay of more than 2 days. The Hosmer-Lemeshow test denoted a good model fit (χ�=12.2, p=0.14). Conclusions Both organization and medical problems accounted for delays of surgical treatment of hip fractures. A multidisciplinary approach, with early input by medical and anaesthetic teams, is needed for managing elderly patients with hip fracture. The availability of the operating theater during the weekend and established protocols aimed to optimize the patient flow logistics may be crucial to make hospitals more patient-centered and to improve patient outcomes