NEW YORK (Reuters Health) – Elderly individuals who fracture a hip have a reduced mortality risk if they undergo surgery within 1 to 3 days, a Canadian team has found.

Between 14% and 36% of elderly individuals with hip fracture die within a years, Dr. Mohit Bhandari at McMaster University, Hamilton, Ontario and colleagues point out in the Canadian Medical Association Journal published online September 13th. While early treatment of hip fracture is recommended to improve functional outcome, sometimes treatment is delayed to optimize patients’ medical status.

To determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture, the team identified 16 relevant observational studies to perform a meta-analysis. “Although the studies we included have methodological limitations, they represent the best available evidence to guide surgical practice,” Dr. Bhandari commented via email.

Five studies, covering a total of 4208 patients and 721 deaths, provided adjusted mortality risks with earlier surgery (within 24 to 72 hours) relative to delayed treatment. “On the basis of the pooled adjusted estimates, early surgery was associated with a 19% risk reduction in all-cause mortality, irrespective of the time of the outcome assessment (relative risk 0.81, p=0.01),” the researchers found.

Four studies reported postoperative complications in 5377 patients. Unadjusted relative risks with early versus delayed surgery were 0.59 (p=0.02) for pneumonia and 0.48 (p<0.001) for pressure sores, but the risk of DVT or pulmonary embolism was unaffected. So, should all patients with hip fractures be operated on as soon as possible? “I’m not entirely sure,” said Dr. Bhandari. “Patients who are medically unstable may benefit from a delay to optimize their medical condition before surgery. Given the ongoing uncertainty, we need a larger, definitive study — ideally one that randomizes patients to earlier surgery.” Reference:
Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

CMAJ 2010;