Pre-Hospital Delays Affect Mortality Rates in Geriatric Hip Fractures

Pre-hospital delays and comorbidities are risk factors for short-term mortality following hip fractures in geriatric patients.

Surgery is recommended within 24-48 hours for geriatric hip fractures. In developing countries, however, delayed presentation to the hospital due to various factors often precludes surgery from occurring within these recommended intervals. This study was undertaken in India and included 78 geriatric patients, in order to identify the hurdles that prevent early surgery for geriatric hip fractures and assess their effect on mortality.

 The results of the study indicated that:

• The mean injury-to-surgery time was 7.43 days.
• A total of 41% of the patients presented to the hospital more than 48 hours after the injury. The reasons cited for the delays were a lack of local healthcare infrastructure, a lack of care providers, financial constraints, and a lack of knowledge. Financial constraints caused the longest mean delay to the admission of 11.57 days. 
• 32% underwent a delay of more than 96 hours before surgery. Patient related medical factors accounted for 21.3% of these extensive delays. Medical organizational causes resulted in 24% of the delays, while 20% were the result of surgical organizational delays. 
• Pre-hospital delays and comorbidities were risk factors for short-term mortality following hip fractures.

According to the authors, the findings of this study underline the need to generate awareness, improve the referral chain, and set up protocol-based care in hospitals to reduce the delay in presentation to the hospital. Further studies are required to assess the socio-economics of delayed treatment of geriatric hip fractures in developing countries.

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