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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Orthop+Traumatol
2016 ; 17
(3
): 207-13
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Achieving hip fracture surgery within 36 hours: an investigation of risk factors
to surgical delay and recommendations for practice
#MMPMID26611677
Aqil A
; Hossain F
; Sheikh H
; Aderinto J
; Whitwell G
; Kapoor H
J Orthop Traumatol
2016[Sep]; 17
(3
): 207-13
PMID26611677
show ga
BACKGROUND: The UK hip fracture best practice tariff (BPT) aims to deliver hip
fracture surgery within 36 h of admission. Ensuring that delays are reserved for
conditions which compromise survival, but are responsive to medical optimisation,
would help to achieve this target. We aimed to identify medical risk factors of
surgical delay, and assess their impact on mortality. MATERIALS AND METHODS:
Prospectively collected patient data was obtained from the National Hip Fracture
Database (NHFD). Medical determinants of surgical delay were identified and
analysed using a multivariate regression analysis. The mortality risk associated
with each factor contributing to surgical delay was then calculated. RESULTS: A
total 1361 patients underwent hip fracture surgery, of which 537 patients
(39.5 %) received surgery within 36 h of admission. Following multivariate
analyses, only hyponatraemia was deduced to be a significant risk factor for
delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity
score matching process, a Pearson chi-square test failed to demonstrate a
statistical difference in mortality incidence between the hypo- and
normonatraemic patients [? (2) (1, N = 512) = 0.10, p = 0.757]. CONCLUSIONS: Hip
fracture surgery should not be delayed in the presence of non-severe and isolated
hyponatraemia. Instead, surgical delay may only be warranted in the presence of
medical conditions which contribute to mortality and are optimisable. LEVEL OF
EVIDENCE: III.