Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls

F. B. Rogers, S. R. Shackford, M. S. Keller

Research output: Contribution to journalArticle

138 Scopus citations

Abstract

Objective: To determine the effect of the timing of fracture fixation and the physiologic status on admission of elderly patients with hip fractures from low impact falls un resource utilization and outcome. Methods: A 5-year retrospective review of 82 elderly (age > 65 years) patients with isolated low-impact hip fractures stratified into early (<24 hours), intermediate (24 to 72 hours), and late (>72 hours) operative fixation. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores, number of comorbidities, fracture type, complication rate, length of stay, discharge acuity, and mortality were calculated for each group. Results: Values are mean ± SD. The mean admission APACHE II score of the entire group was 8.1 ± 0.2, indicating that these patients were physiologically stable on arrival. The mean numbers of comorbidities or APACHE II were not significant between groups. No differences existed in the mean APACHE II scores for survivors and nonsurvivors (7.95 ± 2.34 vs. 9.17 ± 3.06, p = 0.2409). There were no differences in the mean APACHE II scores and predicted survival for each group. However, a significant decrease in actual survival was observed with late fixation (p < 0.001; Fisher's Exact Test). Patients who were fixed late also had a significantly higher infectious morbidity (p = 0.00469), length of stays (p = 0.0226), and total hospital cost (p = 0.0001), compared with those fixed early or immediate, despite having no difference in average acuity upon discharge (p = 0.3883). Conclusions: Delay in fracture fixation, in elderly patients who are physiologically stable on admission, significantly increases morbidity and mortality and adversely affects resource utilization.

Original languageEnglish
Pages (from-to)261-265
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume39
Issue number2
DOIs
StatePublished - Sep 12 1995
Externally publishedYes

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