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· DOS Abstracts
Impact of comorbidity on the association between
surgery delay and mortality in hip fracture patients: a
Danish nationwide cohort study
Buket Öztürk, Søren P. Johnsen, Niels D. Röck, Alma B. Pedersen
Department of Clinical Epidemiology, Aarhus University Hospital
Background:
The effect of the timing of hip fracture surgery on mortality was
studied extensively but the findings are not conclusive. It is generally thought
that earlier surgery leads to lower mortality, but the correct threshold is un-
known.
Purpose / Aim of Study:
To investigate whether the association between sur-
gery delay and mortality varies by comorbidity level.
Materials and Methods:
Using data from Danish registers, 24,819 hip frac-
ture surgery patients (2008 – 2012) were identified. 30-days and 31-365-
days all-cause mortality was determined. Adjusted Odds Ratios (OR) and Haz-
ard Ratios (HR) with 95% confidence interval (CI) were calculated. We defined
comorbidity according to Charlson Comorbidity Index (CCI): low (score of 0),
medium (score of 1-2) and high (score of 3+).
Findings / Results:
ORs for 30-days mortality in patients with low CCI were
1.20 (CI: 1.03;1.39) if surgery delay was >24 vs <24 hours and 1.46 (CI:
1.12;1.92) if surgery delay was >48 vs <48 hours. This increase in 30-days
mortality was not p present for patients with medium or h high CCI. HRs for
31-365 days mortality in patients with low CCI were 1.10 (CI: 1.00;1.22) for
surgery delay >24 vs <24 hours and 1.20 (CI: 1.00;1.44) for surgery delay
>48 vs <48 hours. In patients with medium CCI corresponding HRs were 1.12
(CI: 1.02;1.23) and 1.27 (CI: 1.07;1.50). No increase in 31-365 days mortality
was p present among patients with high CCI.
Conclusions:
The association between surgery delay and mortality is depen-
dent on the presence of comorbidity at the time of the hip fracture. Mortality
is increased among hip fracture patients free of comorbidity when surgery is
delayed >24 hours, while patients with high comorbidity do not have the same
increased mortality when surgery is delayed. These findings may reflect differ-
ences in the optimization focus depending on the level of comorbidity.
No conflicts of interest reported
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