Podium (General) 10

The Effects on Timing of Surgery for Traumatic Hip Fractures In Elderly Patients In A Tertiary Hospital In Cebu City From 2016-2019

Earl Nicholas E. Desquitado, M.D.

Background: Hip fractures are common and serious: they always cause short-term pain, disability and can lead to longer-term pain, disability and even deformity. This is common in the elderly population and usually is a result of a fall. In these cases, surgery is the mainstay of care and time to surgery may be decisive. Some studies report that preoperative delay might lead to an increase in mortality and adversely influence other clinical outcomes such as infection and pressure sores. However, several observational studies found no association between time and mortality and concluded that further research is needed on whether functional outcomes are worsened by delaying surgery thus this study.

Objective: To determine the effect on timing of surgery in elderly patients with traumatic hip fractures treated surgically

Materials and Methods: This is a retrospective cross-sectional study conducted in a tertiary care institution. This study included all elderly patients aged 65 years old and above with hip fractures admitted in a 660-bed capacity hospital in Cebu City, Cebu from January 2016 to December 2019 and who were treated surgically. A retrospective chart review was done to record the surgical time, amount of blood loss, length of hospital stay and condition upon discharge (ambulatory or nonambulatory). A phone call was also made to the subjects to assess the functional outcome using the Oxford Hip scoring system. Results were then tabulated and analyzed.

Results:  A total of 121 patients underwent hip surgery within the period of 2016 to 2019 in the selected tertiary hospital. Of these, a total of 25 patients were excluded (expired, bedridden and no response on follow up). Of the remaining patients (n=92), 42% (n=39) had surgery with in 48 hours or less and 58% (n=53) for those who had hip surgery more than 48 hours from the time of injury to the time of operation. The mean age of both groups were 75-76 years old and 77-79% of the population were female. Fractures were also mostly located at the femoral neck accounting to 84-89%. Patients who were operated within 48 hours were discharged 2 days earlier than those who underwent surgery after 48 hours after the time of injury and better functional outcome with a mean Oxford Hip Score of 44.87.

Conclusion. This study showed that the patients who were operated less than 48 hours from the time of injury had shorter hospital stay and better functional outcome using the Oxford Hip Score. Other variables such as blood loss, surgical time and condition of the patient upon discharge were similar with those patients treated in less than 48 hours and those treated more than 48 hours from injury

Recommendations: The researcher recommends conducting further studies focused on the factors affecting the time of surgery and how this could affect the outcomes of surgery and also doing research on the effects of early surgery on subsets of patients with hip fractures.