Hip fracture patients should be operated on within 24 hours of hospital admission because early surgery reduces pain, shortens hospital stays, and may limit the risk of major complications, such as pneumonia and arrhythmias, according to the authors of a new study supported by the Agency for Healthcare Research and Quality (HS09459 and HS09973). The benefits of early hip fracture surgery have long been debated within the medical community, but no randomized controlled trials have been conducted. Almost all of the research that has been conducted to date has examined early surgery's impact on death rates, according to the study authors.
Researchers led by Albert L. Siu, M.D., of Mount Sinai School of Medicine, examined roughly 1,200 patients in New York City hospitals who underwent hip fracture surgery. Adjusted findings show that early surgery had no impact on survival or functional ability by 6 months after discharge. However, the majority of patients reported severe pain on admission. Patients with early surgery had lower pain scores than patients who had later surgery, a difference that translated into between 6 and 7 fewer hours of severe pain, on average, during the first 5 days of hospitalization. In addition, the early surgery patients' hospital stays were on average nearly 2 days shorter than those of the later surgery patients (7.07 vs. 9.43). All of the patients were in stable medical condition prior to surgery.
Patients often suffer severe pain before surgery is performed to repair the break, and only about one-quarter of patients make a full recovery. Between 14 percent and 36 percent of hip fracture patients die within 12 months from complications related to the fracture and recovery period.
For more information, see "The association of timing of surgery for hip fracture and patient outcomes," by Gretchen M. Orosz, M.D., Jay Magaziner, Ph.D., Edward L. Hannan, and others, in the April 14, 2004, Journal of the American Medical Association 291(14), pp. 1738-1743.