THE EFFECT OF EXPEDITED SURGERY IN FRAIL ELDERLY HIP FRACTURE PATIENTS
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Abstract
BACKGROUND: Early hip fracture surgery within 24-72 hours of hospitalization can significantly reduce complications and 1 year mortality. However, there is limited research on the clinical outcomes of expedited surgery in frail elderly patients.
OBJECTIVE: To evaluate the outcomes of expedited surgery in terms of mortality rate, complications, and quality of life in frail elderly patients with hip fractures.
METHODS: This research was a retrospective study of the frail elderly patients with hip fractures admitted for surgery at Chiangrai Prachanukroh Hospital from January 1, 2012 to December 31, 2021. Age, gender, weight, height, pre-existing conditions, type of hip fracture, type of surgery, Barthel index, post-surgical complications and mortality within 30 days were obtained via a medical record review and the mortality at 1 year was collected via phone calls. The patients were divided into 3 groups using the waiting time to surgery: < 48, 48-72, and > 72 hours. The data analyzed using descriptive statistics and inferential statistics.
RESULTS: The total patients were 379 patients with mean age 76.67±9.06 years. There was 267 or 70.45% with extra-articular fracture, and 112 or 29.55% with intra-articular fracture. The surgical timing groups were <48 hours (145 patients, 38.26%), 48-72 hours (73 patients, 19.26%), and >72 hours (161 patients, 42.48%). Complications were found in 15.17%, 20.55%, and 14.29% of patients in the <48 hours, 48-72 hours, and >72 hours groups, respectively. The most common complication was a urinary tract infection, and there was no significant difference in complication rate, Barthel index score and mortality rates between the groups. Bed ridden patients accounted for 4.61% in the <48-hour group, 11.11% in the 48-72-hour group, and 5.17% in the >72-hour group. Six patients died within 1 month, all due to respiratory system complications, and 9 patients died within 1 year.
CONCLUSIONS AND RECOMMENDATIONS: There was no significant difference in postoperative complications, quality of life, and mortality rate due to expedited surgery in frail elderly patients with hip fractures. Complications that lead to mortality within the first month are respiratory tract infections. Monitoring and preventing complications that may occur are more important than expedited surgery in reducing mortality in this patient group.
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