The Influence Of Admission Timing On Surgical Outcomes In Elderly Hip Fracture Patients:A Retrospective Study

Background: The influence of surgical timing on postoperative prognosis has been extensively studied.But most studies only emphasize surgery opportunity after admission,without considering the waiting time before admission.Therefore,the aim of this research was to investigate the effect of admission delay on clinical outcomes and determine the right timing for admission.Methods: In this study,we reviewed hip fractures patients over 65 years old who underwent surgery in the Second Affiliated Hospital of Zhejiang University School of Medicine between 2014 and 2017.The main study factor was admission timing.The main outcome was 1-year mortality.The secondary outcomes included 1-month mortality,in-hospital mortality,ICU occupancy,new onset pneumonia,new onset pulmonary embolism/ deep vein thrombosis(PE/DVT),length of stay and total hospital expenses.An univariate Logistic regression was carried out first between different admission timings and 1-year mortality to determine an appropriate one,then the basic data and outcomes were compared between patients with different admission timing,and finally Cox survival analysis was carried out to compare the difference of survival status within one year after operation between both groups.Results: We included 970 patients in this study and followed up 89.4%(867)of them.Among those patients,the proportion of admitted in day 0(the same day),day 1,day 2,day 3 and thereafter were 25.4%(220),29.3%(254),11.6%(101)and 33.7%(292).87.4%(758)and 12.6%(109)patients visited hospital within one week and one week later after injury,respectively.The 1-year mortality rate was 10.5%(91).1-year mortality of the patients who admitted within or after one week of injury were 9.6%(73)and 16.5%(18),respectively.The difference between the two was statistically significant(P = 0.028).There were no significant differences in other clinical outcomes between both groups.Cox survival analysis revealed a significant increase in death risk for patients admitted one week after injury in the first postoperative year(HR: 1.746,95% CI: 1.021-2.987,P = 0.042).Conclusions: One week's delay of admission was associated with increased 1-year mortality,but not other clinical outcomes.We suggest that elderly hip fracture patients admitted to hospital as soon as they can once injured,especially not more than one week later.