48 * DELAY OR CANCELLATION OF SURGERY FOR HIP FRACTURE PATIENTS

Abstract

Introduction: Early surgery for hip fracture is associated with reduced pain and decreased mortality and length of stay.Method: An audit of delay/cancellation of operative management of hip fracture in a UK teaching hospital during 24 months period. Delay/ Cancellation causes were divided into avoidable and unavoidable categories. Avoidable causes include full operative list, bed unavailability, awaiting pacemaker checks, consent not taken, and delayed group & save. Unavoidable reasons included medical unfitness, chest, cardiac reasons and advanced malignancy.Results: Total number of hip fracture patients admitted was977,6were excluded because of incomplete documentation and 971were included.15 %(147/971)of patients were delayed/cancelled;103 Females and 44 male. The mean age was 84.9and 81.5years respectively.54% (80/147) of the delay/ cancellations were potentially avoidable.20% (30/147)were due to full list/ lack of theatre time. Further investigations were requested but could not be done in a timely fashion in 9% (13/147) of cases. Decision for surgery was changed in 7% (11/147) of cases but this was too late to add other cases on the list. 5%(7/147)were delayed due to raised INR that was not recognised earlier or not given antidote in time. In 12(16/147) reasons were related to delayed group and save lack of consent and bed availability. 46% (67/147) of delay/cancellations were unavoidable. 16% (23/147) were medically unstable; 9% (13/147) had chest infections,4%(6/147) had cardiac disease, 5% (7/147) had fast atrial fibrillation. 7% (10/147) were due to raised INR that was not normalised despite vitamin K injection. 4% (6/147) had, extensive metastasis in which prophylactic fixation was not possible.Conclusion: More than 50% of the causes of delay of operative management of hip fracture were avoidable. We suggest early orthogeriatrician involvement and use of a checklist to remind and guide juniors to reduce the delay of surgery.