The Relationship between Pre-Admission Waiting Time and the Surgical Outcomes after Hip Fracture Operation in the Elderly.

ABSTRACT

OBJECTIVES: To investigate the association between pre-admission waiting time and postoperative complications, length of stay (LOS), and costs during hospitalization. METHOD: This was a single-center, observational study. The subjects of this study were elderly hip fracture patients who were admitted to the Department of Orthopedics, West China Hospital, Sichuan University, from December 2010 to June 14, 2017, and that underwent internal fixation or joint replacement surgery. The pre-admission waiting time was treated as a categorical variable according to median and first quartile values. Outcomes included postoperative complications (pneumonia and other complications [urinary tract infection, heart failure, non-A-grade healing]), LOS, and costs during hospitalization. LOS and costs during hospitalization were converted into binary outcomes based upon median values. Binary logistic regression analyses were used to analyze correlations between pre-admission waiting time and patient outcomes. RESULTS: A total of 889 patients 60 years of age and older were enrolled in this study, of whom 65.47% were females and 34.53% were males. The proportion of patients with pre-admission waiting times less than 8 h, 8 - 24 h, and ≥ 24 h were 24.3%, 17.32%, and 58.38%, respectively. Postoperative pneumonia and other complications affected 12.04% and 6.30% of patients, respectively. Relative to patients with the pre-admission waiting times of less than 8 h, those with longer pre-admission waiting times exhibited a higher risk of postoperative pneumonia (8 - 24 h OR = 2.72,95% CI 1.29-5.74, p = 0.009; ≥ 24 h OR = 2.76,95% CI 1.48-5.14, p = 0.001). Patients with the pre-admission waiting time ≥ 24 h also exhibited a higher risk of the other complications (OR = 2.55, 95% CI 1.53-4.26, p <0.001), a longer LOS (OR = 1.43, 95% CI1.02-2.01, p = 0.036), and higher costs during hospitalization (OR = 1.51, 95% CI1.05 - 2.17, p = 0.026) relative to patients with a waiting time less than 8 hours. CONCLUSION: Pre-admission waiting time was associated with postoperative complications, LOS, and hospitalization costs among older Chinese patients undergoing surgery to treat hip fractures.