ผลของช่วงเวลารอการผ่าตัดที่มีต่ออัตราการเสียชีวิตในหนึ่งปีในผู้ป่วยสูงอายุที่กระดูกสะโพกหักบริเวณอินเตอร์โทรแคนเทอริก

Suphawat Tantithawornwat

Authors

Suphawat Tantithawornwat Department of Orthopedics, Samutprakan Hospital

Keywords:

intertrochanteric hip fracture, time to surgery, one-year mortality, complications

Abstract

Hip fractures in elderly are a common condition associated with complications, mortality, loss of mobility, and a substantial burden on healthcare systems. This study aims to compare clinical outcomes between patients who underwent surgery within 72 hours and those who underwent surgery after 72 hours following admission to Samutprakan Hospital.

This retrospective cohort study included patients aged 60 years and older who were diagnosed with intertrochanteric hip fractures and underwent internal fixation with Proximal Femoral Nail Antirotation (PFNA) at Samutprakan Hospital between January 1, 2019 and December 31, 2024. A total of 451 patients were enrolled and categorized into two groups according to time to surgery: surgery within 72 hours and surgery after 72 hours. The primary outcome was 1-year mortality from the date of hospital admission. Secondary outcomes included postoperative complications and length of hospital stay. Data were analyzed using descriptive statistics, Independent t-test, Mann–Whitney U test, Chi-square test, or Fisher’s exact test as appropriate. Risk Ratio (RR), 95% confidence intervals (CI), and p-values were reported.

The results showed that among 451 patients, most underwent surgery within 72 hours (60.3%). The overall 1-year mortality rate was 8.6%. There was no statistically significant difference in 1-year mortality between the two groups (p = 0.169). Patients who underwent surgery after 72 hours had a 1.60-fold higher risk of 1-year mortality compared with those who underwent surgery within 72 hours; however, the difference was not statistically significant (RR = 1.60; 95% CI: 0.88–2.91). Nevertheless, delayed surgery beyond 72 hours was significantly associated with higher rates of urinary tract infection (p < 0.001), higher rates of pressure ulcers (p = 0.017), and a longer median length of hospital stay (p < 0.001).

References

Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res. 2023;38(8):1064-75. doi:10.1002/jbmr.4821.

Tian C, Shi L, Wang J, Zhou J, Rui C, Yin Y, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr. 2025;133:105832. doi:10.1016/j.archger.2025.105832.

Charatcharoenwitthaya N, Nimitphong H, Wattanachanya L, Songpatanasilp T, Ongphiphadhanakul B, Deerochanawong C, et al. Epidemiology of hip fractures in Thailand. Osteoporos Int. 2024;35(9):1661-8. doi:10.1007/s00198-024-07140-2.

Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis. JB JS Open Access. 2019;4(1):e0045. doi:10.2106/JBJS.OA.18.00045.

Haentjens P, Autier P, Barette M, Venken K, Vanderschueren D, Boonen S, et al. Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone. 2007;41(6):958-64. doi:10.1016/j.bone.2007.08.026.

Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318(20):1994-2003. doi:10.1001/jama.2017.17606.

Klestil T, Röder C, Stotter C, Winkler B, Nehrer S, Lutz M, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep. 2018;8(1):13933. doi:10.1038/s41598-018-32098-7.

Chen P, Shen X, Xu W, Yao W, Ma N. Comparative assessment of early versus delayed surgery to treat proximal femoral fractures in elderly patients: a systematic review and meta-analysis. Int J Surg. 2019;68:63-71. doi:10.1016/j.ijsu.2019.06.013.

Suttaphakti B, Tananoo S, Thremthakanpon W, Wanitcharoenporn W. Comparison of one-year survival rate of hip arthroplasty performed within and after 72 hours in elderly femoral neck fracture. J Southeast Asian Orthop. 2023;47(2):3-10. doi:10.56929/jseaortho-023-0173.

Chaimuang C. A comparative study of postoperative complications in patients undergoing hip fracture surgery within 48 hours and 72 hours at Chiangkham Hospital, Phayao Province. Health Sci Technol Rev. 2024;17(3):54-65.

Tanasubsinn N. Outcomes of hip fracture surgery in elderly patients with high American Society of Anesthesiologists physical status: a comparison of surgery within 72 hours versus after 72 hours. Lampang Med J. 2024;45(1):28-34.

Karoonvatana C. A retrospective study in elderly patients with hip fractures at Bangplee Hospital: delayed surgery is associated with increased morbidity, mortality, and length of stay. Samut Prakan Hosp J. 2025;3(2):49-57.

ธัญทัต เลื่องเลิศ. การศึกษาเปรียบเทียบอัตราการเสียชีวิตในปีแรก และภาวะแทรกซ้อนในผู้ป่วยกระดูก สะโพกหักจากภยันตรายที่ไม่รุนแรงที่ได้รับการผ่าตัดภายในระยะเวลา 72 ชั่วโมง และหลัง 72 ชั่วโมงในโรงพยาบาลโพธาราม. วารสารอนามัยสิ่งแวดล้อมและสุขภาพชุมชน. 2567;9(2):29-37.

Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-16. doi:10.1503/cmaj.092220.

Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ. 2006;332(7547):947-51. doi:10.1136/bmj.38790.468519.55.

Lewsirirat S, Thanomsingh P. Mortality and ambulatory status after intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand. J Royal Coll Orthop Surg Thai. 2010;34:5-12.

Daraphongsataporn N, Saloa S, Sriruanthong K, Philawuth N, Waiwattana K, Chonyuen P, et al. One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand. Osteoporos Sarcopenia. 2020;6(2):65-70. doi:10.1016/j.afos.2020.05.005.

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573-9. doi:10.1001/jama.2009.1462.