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Temporal Trends in Hip Fractures: How Has Time-to-Surgery Changed?

Background
Surgical fixation of hip fractures within 24-48 hours of hospital presentation is associated with decreased rates of postoperative morbidity and death, and recently, hospitals nationwide have implemented strategies to expedite surgery. Our aim was to describe how time-to-surgery and short-term complication rates have changed using the National Surgical Quality Improvement Program database from 2011 to 2017.


Methods
We identified more than 73,000 patients aged ≥65 years who underwent surgical fixation. Poisson regression adjusting for comorbidities, surgery type, type of anesthesia, patient sex, and patient age was performed to quantify annual changes in time-to-surgery. Annual changes in 30-day postoperative complications were analyzed using a generalized linear model with binomial distribution.


Results
A significant decrease in time-to-surgery was observed during the study period (mean 30 hours in 2011 versus 26 hours in 2017; P<0.001). Time-to-surgery decreased by 2% annually during the 7-year period (0.5 hour/year, 95% CI: -35, -23; P<0.001). The all-cause 30-day complication rate also decreased annually (annual risk difference: -0.35%, 95% CI: -0.50%, -0.20%; P<0.001). For individual complications, we found significant decreases in deep infection (-0.2%, P=0.002), reintubation (-0.3%, P=0.001), urinary tract infection (-2.5%, P<0.001), and death (-1.3%, P=0.03). We found significant but small increases of pulmonary embolism (0.3%, P=0.03) and myocardial infarction (0.1%, P=0.02). Higher rates of complications were associated with increased time-to-surgery (P<0.001).


Conclusion
From 2011 to 2017, time-to-surgery for hip fracture decreased significantly, as did short-term postoperative rates of all-cause complications and death. Longer time-to-surgery was associated with increased number of complications.