Hip fracture outcomes worse during busy periods

Hip fractures are serious, especially for the elderly. The operation can be a great strain, and 13 per cent of patients over the age of 70 do not survive 60 days after the fracture.

When the operating room is busy, 20 per cent more patients die within 60 days after the operation.

Their chance of survival may depend on how busy the surgeons are with other emergency procedures.

“When the operating room is busy, 20 per cent more patients die within 60 days after the operation,” says Professor Johan Håkon Bjørngaard at NTNU’s Department of Public Health and Nursing.

Surgeons can get especially busy during periods when the patient demand for surgery is high. In busy periods, hip fracture patients have to wait on average 20 per cent longer before being operated on compared to the quiet periods. This wait can have serious consequences.

Reviewed 60 000 hip procedures

Information from over 60 000 hip surgeries and all simultaneous emergency surgeries provided the research group from St. Olavs Hospital and NTNU with a solid numerical basis.

“We investigated how many older people over the age of 70 died during the first 60 days following a hip operation when particularly many emergency patients were queued up for surgery at the hospitals,” say researchers Andreas Asheim and Sara Marie Nilsen from the Regional Center for Health Services Development (RSHU) at St. Olavs Hospital.

During busy periods, 40 per cent of the patients waiting in the operating wards are typically people who have recently been brought in for emergency surgery. In the quietest periods, the percentage can drop to 25 per cent.

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Elderly the most impacted

Older people often have to undergo surgery for hip fractures. The average age of hip surgery patients in the study was 85, with women making up 72 per cent. The median wait time before being operated on was about 20 hours.

Older people naturally have a greater risk of dying than the average population has. Age is one reason why mortality is high following surgery.

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Prioritizing issue

The capacity of the hospitals also plays a major role.

Previous results show that patients who are operated on for hip fractures have a higher risk of dying if they are discharged from the hospital early due to lack of space.

Hip fracture patients may need to be prioritized in the queue to increase their chances of survival.

Prioritizing patients “is part of a discussion about organizing emergency surgery. This could mean that we need to screen surgery hip fracture patients more than what’s currently being done,” says orthopaedist Lars Gunnar Johnsen.

Reference: Sara Marie Nilsen, Andreas Asheim, Fredrik Carlsen, Kjartan Sarheim Anthun, Lars Gunnar Johnsen, Lars Johan Vatten, Johan Håkon Bjørngaard. High volumes of recent surgical admissions, time to surgery, and 60-day mortality a cohort study of 60,000 Norwegian hip fracture patients. The Bone & Joint Journal. Published Online:1 Feb 2021 https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-1581.R1