Hip fracture patients should be operated on within 24 hours to reduce pain

Hip fracture patients should be operated on within 24 hours of hospital admission because it reduces pain, shortens hospital stays and may limit the probability of major complications occurring, such as pneumonia and arrhythmias, according to the authors of a new study supported by the Agency for Healthcare Research and Quality. The study appears in the April 14 issue of the Journal of the American Medical Association.

The benefits of early hip fracture surgery have long been debated within the medical community, but no randomized controlled trials have been conducted and almost all the research that has been conducted to date has examined early surgery’s impact mainly on death rates, according to the authors.

Researchers led by Albert L. Siu, M.D., of Mount Sinai School of Medicine, examined roughly 1,200 patients in New York City hospitals who underwent hip fracture surgery. Adjusted findings show that early surgery had no impact on survival or functional ability by six months after discharge. However, the majority of patients reported severe pain on admission, and patients with early surgery had lower pain scores than did later surgery patients, a difference that translated into between six and seven fewer hours of severe pain, on average, during the first five days of hospitalization. In addition, the early surgery patients’ hospital stays averaged nearly two days shorter than those of the later surgery patients (7.07 versus 9.43). All the patients were in stable medical condition prior to surgery.

Patients often suffer severe pain before surgery is performed to repair the break, and only about a quarter make a full recovery. Between 14 percent and 36 percent of hip fracture patients die within 12 months from complications related to the fracture and recovery period.

Details are in “The Association of Timing of Surgery for Hip Fracture and Patient Outcomes,” published in the April 14 issue of the Journal of the American Medical Association.