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Unlabelled: The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture., Introduction: To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival., Methods: The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined., Results: Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p  =  0.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p < 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p = 0.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p= 0.185)., Conclusions: If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

Unlabelled: This study aims to analyze whether the interval from hospital admission to surgery may be used as a surrogate of the actual gap from fracture to surgery when investigating in-hospital hip fracture mortality. After analyzing 3,754 hip fracture admissions, we concluded that those intervals might be used interchangeably without misinterpretation bias., Introduction: The debate regarding the influence of time to surgery in hip fracture (HF) mortality is one of the most controversial issues in the HF medical literature. Most previous investigations actually analyzed the time from hospital admission to surgery as a surrogate of the less easily available gap from fracture to surgery. Notwithstanding, the assumption of equivalency between those intervals remains untested., Methods: We analyzed 3,754 hospital admissions of elderly patients due to HF in Quebec, Canada. We compared the performance as predictors of in-hospital mortality of the delay from admission to surgery and the actual gap from fracture to surgery using univariate and multiple logistic regression analysis., Results: The mean times from fracture to surgery and from admission to surgery were 1.84 and 1.02 days (P < 0.001), respectively. On univariate logistic regression, both times were slightly significant as mortality predictors, yielding similar odds ratios of 1.08 (P < 0.001) for time from fracture to surgery and 1.11 (P < 0.001) for time from admission to surgery. After accounting for other covariates, neither times remained significant mortality predictors., Conclusion: The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.

Objective: The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil., Discussion: We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time-1-30 days, 31-90 days, and 91-365 days after hospital admission-and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge., Results: We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.