Delayed surgery may affect fracture recovery

NEW YORK (Reuters Health) - An elderly person who has fractured their femur - the large thigh bone that connects the leg to the hip - may want to have surgery sooner rather than later, according to a study linking longer times to surgery to a somewhat increased risk of post-surgery complications.

Dr. Rudiger Smektala from Ruhr University Bochum in Bochum, Germany, and colleagues used data from a study on hip fractures at 286 hospitals to determine whether elderly patients benefit from early surgical treatment for these common fractures.

Just over a quarter of patients had surgery within 12 hours of the fracture, 41 percent had surgery within 12 to 36 hours, and roughly 32 percent more than 36 hours after the fracture.

Patients in the longer time-to-surgery groups were somewhat more likely to develop pressure sores, urinary tract infections, blood clots, or pneumonia, the team found, whereas patients who received surgery early were somewhat more likely to develop postoperative bleeding or implant complications.

None of these differences, however, reached statistical significance.

Time to surgery had no influence on risk of death in the year after surgery, the researchers note.

“(Our study) shows a trend toward more frequent postoperative complications in the longest time-to-surgery group, but no effect of time-to-surgery on mortality,” they conclude.

They also note that the longest time-to-surgery group had a somewhat higher percentage of patients with multiple illnesses than the other two groups.

“A subject that merits further research is that of the so-called ’stable’ patients, a specific subgroup of hip-fracture patients that, in the view of numerous authors, benefits from the shortest possible time-to-surgery,” the investigators say.

SOURCE: BMC Musculoskeletal Disorders, December 29, 2008.


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