Propensity score matching analysis of early vs. delayed surgery for intertrochanteric fracture in older patients: a retrospective multicenter cohort study of 7414 patients with a mean 4-year follow up

Oct 12, 2024BMC geriatrics

Comparing early and delayed surgery for hip fractures in older patients using matched data from 7,414 cases over 4 years

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Abstract

A 48-hour delay in surgery for older patients with intertrochanteric fractures is associated with no significant differences in mortality or major complications compared to early surgery.

Surgery duration, intraoperative blood loss, and transfusion rates were similar between early and delayed surgery groups.
Functional outcomes and rates of severe, cardiac, pulmonary, and neurological complications showed no significant differences regardless of surgery timing.
Patients undergoing early surgery had a shorter hospital stay (mean 11.5 days vs. 14.4 days) and lower total hospital costs (mean 39,305 yuan vs. 42,048 yuan).
Rates of minor complications, such as hematological (31.7% vs. 41.2%) and nutritional/metabolic (59.3% vs. 66.4%), were lower in the early surgery group.
Patients receiving early surgery required more blood transfusions on average (2.8 units vs. 2.2 units).

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BACKGROUND: The widespread acceptance of early surgery as a treatment for acute (ITF) has been accompanied by ongoing controversy due to conflicting conclusions presented in previous studies. This study aims to compare the occurrence of perioperative complications and mortality, as well as functional outcomes in older patients with ITF who underwent either early or delayed surgery.

METHODS: A retrospective multicenter cohort study involving 7414 patients with ITF between Jan. 2017 and Dec. 2021 was conducted. After predefined participants selection inclusion and exclusion criteria, 2323 surgically treated ITF patients were included and analyzed utilizing propensity score matching (PSM) method. Their demographics, injury-related data, surgery-related data, and perioperative adverse outcomes during hospitalization were collected and compared between the early or delayed surgery groups by PSM with a 1:4 ratio. All participants received a minimum of two-year follow-up and perioperative outcomes, functional outcomes, and survival analyses were conducted and compared.

RESULTS: After adjustment for potential confounders, there were no significant difference in surgery duration, intraoperative blood loss, transfusion rate, mortality rates, functional outcomes, and perioperative complications rates including severe complications, cardiac complications, pulmonary complications, and neurological complications regardless of whether the patient was treated with early or delayed surgery (all P > 0.05). Although length of hospital stay (mean, 11.5 versus 14.4 days, P < 0.001), total hospital costs (mean, 39305 versus 42048 yuan, P < 0.001), and minor complications rates including hematological complications (31.7% versus 41.2%, P = 0.007) and nutritional/metabolic complications (59.3% versus 66.4%, P = 0.039) were lower in the early surgery group, our result indicated patients with early surgery were more inclined to receive more blood transfusion (mean, 2.8 versus 2.2 units, P = 0.004).

CONCLUSIONS: Our findings suggest that a 48-hour delay in surgical intervention for older patients with an ITF does not result in a higher mortality rate, worse functional outcomes, and increased incidence of major perioperative complications when compared to early surgery. While expedited surgery is undoubtedly necessary for suitable patients, a reasonable preoperative delay of 48 h may be justified and safe for those with severe conditions, rather than strictly adhering to the current guidelines.

Key numbers

11.5 days

Length of Hospital Stay

Mean length of stay for early surgery group.

39305 yuan

Total Hospital Costs

Mean costs for early surgery group.

31.7%

Minor Complications Rate Increase

Rate of hematological complications in delayed surgery group.

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Propensity score matching analysis of early vs. delayed surgery for intertrochanteric fracture in older patients: a retrospective multicenter cohort study of 7414 patients with a mean 4-year follow up

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