Objective: To determine the effect of the timing of fracture fixation and the physiologic status on admission of elderly patients with hip fractures from low impact falls on resource utilization and outcome.
Methods: A 5-year retrospective review of 82 elderly (age > 65 years) patients with isolated low-impact hip fractures stratified into early (< 24 hours), intermediate (24 to 72 hours), and late (> 72 hours) operative fixation. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores, number of comorbidities, fracture type, complication rate, length of stay, discharge acuity, and mortality were calculated for each group.
Results: Values are mean +/- SD. The mean admission APACHE II score of the entire group was 8.1 +/- 0.2, indicating that these patients were physiologically stable on arrival. The mean numbers of comorbidities or APACHE II were not significant between groups. No differences existed in the mean APACHE II scores for survivors and nonsurvivors (7.95 +/- 2.34 vs. 9.17 +/- 3.06, p = 0.2409). There were no differences in the mean APACHE II scores and predicted survival for each group. However, a significant decrease in actual survival was observed with late fixation (p < 0.001; Fisher's Exact Test). Patients who were fixed late also had a significantly higher infectious morbidity (p = 0.00469), length of stays (p = 0.0226), and total hospital cost (p = 0.0001), compared with those fixed early or immediate, despite having no difference in average acuity upon discharge (p = 0.3883).
Conclusions: Delay in fracture fixation, in elderly patients who are physiologically stable on admission, significantly increases morbidity and mortality and adversely affects resource utilization.