The impact of preoperative medical clearance procedures on the time to definitive surgical management of hip fractures

Background: Clinical management guidelines usually advocate the surgical treatment of hip fractures within 20-48 hours of hospitalization, although many older patients present with significant medical conditions that require detection and possibly stabilization before surgery. The merits of an extensive preoperative medical workup versus a timely surgical intervention remain controversial. The objective of this study was to examine the effect of preoperative medical clearance procedures on the time from hospital admission to definitive surgical intervention in patients with hip fractures. Methods: A total of 115 patients (mean age 78.2, range 50-102 years) admitted to a single level I trauma center from January 2009 to December 2011 for subtrochanteric, intertrochanteric, or femoral neck fractures met the inclusion criteria and were retrospectively reviewed. The diagnostic tests analyzed were electrocardiography (ECG), echocardiography (ECHO), cardiac stress testing (CST), CT, and MRI, as well as patient age. Multiple linear regression analysis (alpha=0.05) was performed to determine the effect of diagnostic clearance tests on the time to definitive surgical intervention. Results: The time from hospitalization to surgery was more than 48 hours in 26 (20%) patients. Patient age and ECG were not significantly associated with increased time to definitive surgical intervention. All other surgical clearance diagnostic procedures (ECHO, CT, CST, and MRI) were significantly associated to increased time to surgery (P<0.004 in all cases). Conclusions: These findings suggest that improved access to preoperative diagnostic procedures is warranted to expedite the time to surgery in elderly patients with hip fractures.