Can We Accurately Predict Which Geriatric and Middle-Aged Hip Fracture Patients Will Experience a Delay to Surgery?

Abstract

This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery. Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a single academic institution were included. Risk quartiles were constructed using Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) calculations. Negative binomial and multivariable logistic regression were used to evaluate time to surgery and delay to surgery, respectively. Pairwise comparisons were performed to evaluate 30-day mortality rates and demonstrate the effectiveness of the STTGMA tool in triaging mortality risk. Six hundred eleven patients met inclusion criteria with mean age 81.1 ± 10.5 years. Injuries occurred mainly secondary to low-energy mechanisms (97.9%). Median time to surgery (31.9 hours overall) was significantly associated with STTGMA stratification (<i>P</i> = .002). Moderate-risk patients had 33% longer (<i>P</i> = .019) and high-risk patients had 28% longer time to surgery (<i>P</i> = .041) compared to minimal risk patients. Delay to surgery (26.4% overall) was significantly associated with STTGMA stratification (<i>P</i> = .015). Low-risk patients had 2.14× higher odds (<i>P</i> = .009), moderate-risk patients had 2.70× higher odds (<i>P</i> = .001), and high-risk patients had 2.18× higher odds of delay to surgery (<i>P</i> = .009) compared to minimal risk patients. High-risk patients experienced higher 30-day mortality compared to minimal (<i>P</i> < .001), low (<i>P</i> = .046), and moderate-risk patients (<i>P</i> = .046). Patients in higher STTGMA quartiles encountered longer time to surgery, greater operative delays, and higher 30-day mortality. Score for Trauma Triage in the Geriatric and Middle-Aged can quickly identify hip fracture patients at risk for a delay to surgery and may allow treatment teams to optimize surgical timing by proactively targeting these patients. Prognostic Level III.