Surgical consent by healthcare proxies does not delay surgery in older adult patients with hip fracture.

Abstract

To evaluate the effect of obtaining consent from a healthcare proxy on time to surgery in older adult patients with hip fracture. Retrospective cohort study. Single Level 1 Trauma Center. Consecutive patients over a 2-year period with a proximal femur fracture (OTA/AO 31A-C except 31A1.1) older than 70 years were included. Exclusion criteria were nonoperative management, periprosthetic fractures, multiple fracture fixations, admission to nonorthopaedic care, and delay due to anticoagulation usage. Surgical consent forms were evaluated to categorize patients as self-consented (SC) or healthcare proxy-consented (HCPC). Time of presentation-to-surgery (PTS-time) and time of admission-to-surgery (ATS-time). The HCPC group had a significantly longer PTS-time compared with the SC group (median 27.1 hours vs. 22.2 hours, <i>P</i> = 0.036) and no significant difference in ATS-time (median 21.6 hours vs. 17.1 hours, <i>P</i> = 0.077). Weekend admissions and higher Frailty Index correlated with longer PTS- (ρ = 0.268, <i>P</i> < 0.001 and ρ = 0.252, <i>P</i> = 0.001, respectively) and ATS-time (ρ = 0.268, <i>P</i> < 0.001 and ρ = 0.198, <i>P</i> = 0.007, respectively). Adjusted for these variables, there was no significant difference between SC and HCPC groups in PTS-time (<i>P</i> = 0.996) or ATS-time (<i>P</i> = 1.000). In HCPC patients, postoperative delirium (OR 5.98, <i>P</i> = 0.002) and a hospital length of stay over 5 days (OR 2.17, <i>P</i> = 0.008) were more common. Needing healthcare proxy consent does not have a clinically relevant impact on time-to-surgery; however, it does indicate a frail and vulnerable hip fracture patient. Requiring healthcare proxy consent is associated with an increased risk of postoperative delirium and extended hospital length of stay. III.