Compared to patients who got hip fracture surgery within 24 hours
after arriving at the hospital, people who waited longer for
operations were more likely to have complications like heart attack,
blood clots or pneumonia, the study found.
Overall, 5.8% of patients who had hip fracture surgery within 24
hours died, compared with 6.5% of people who had surgery later.
But only about one-third of patients got hip fracture surgery within
“Treatment within 24 hours is not only more humane for patients who
wait bedridden in pain for surgery, but now has been shown to be
associated with fewer complications,” lead study author Dr. Daniel
Pincus of Sunnybrook Hospital and the University of Toronto said by
Guidelines in the U.S. and Canada recommend that patients receive
surgery within 48 hours, Pincus and colleagues note online November
28 in JAMA. The study results suggest that targeting a shorter wait
time for surgery may improve outcomes, the research team concludes.
Researchers examined data on 42,230 adults who had hip fracture
surgery at 72 hospitals in Ontario between 2009 and 2014.
Patients were 80 years old on average, and 71% were women.
On average, patients waited about 39 hours for surgery.
Overall, 7% of the patients died within 30 days of having hip
fracture surgery, the study found.
Operating within 24 hours would prevent 79 deaths for every 100
patients treated, the researchers calculated.
It would also prevent 51 pulmonary embolisms, 39 heart attacks and
95 cases of pneumonia, they estimate.
The study wasn’t a controlled experiment, however, and it cannot
prove whether or how shorter wait times for hip fractures surgery
might influence the odds of complications or death.
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Another limitation is that the researchers didn’t look at some
complications that might be related to wait times for surgery such
as serious bleeding. They also excluded people who died waiting for
surgery, and it’s possible at least some of those patients might
have had a different result with operations within 24 hours.
Even so, the findings suggest that as long as patients are otherwise
healthy and an operating room is available, there isn’t a good
reason to wait for surgery, Pincus said.
Operating sooner, however, may require doctors to rethink their
approach to treating elderly patients with these injuries, said Dr.
Harry Sax, author of an accompanying editorial and executive vice
chair of surgery at Cedars-Sinai Medical Center in Los Angeles.
“We have to accept that an elderly patient who breaks a hip is
already at increased risk for complications,” Sax said by email. “By
putting them on bed rest for several days, we now make them more
likely to get pneumonia, blood clots, pulmonary embolisms, or bed
Patients and families should be prepared for the possibility that a
hip fracture may lead to declining health and death, particularly
for frail elderly people, Sax added.
“Extensive delays may increase rather than reduce that risk,” Sax
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