# Rapid transfer to specialist orthopaedic ward reduces mortality in hip fracture patients, but several factors reduce the ability to achieve the < 4-hour target

## TL;DR

Quick transfer to orthopaedic wards for hip fracture patients reduces 30-day mortality, but factors like out-of-hours admission and comorbidities delay this transfer.

## Contribution

Identifies specific factors affecting timely admission of hip fracture patients and their impact on mortality.

## Key findings

- 19% of patients were admitted within 4 hours to orthopaedic wards.
- Admission delays over 4 hours increased 30-day mortality by 44%.
- Out-of-hours admission and higher comorbidity scores were linked to longer delays.

## Abstract

Hip fractures are one of the most common fracture types in adults. Rapid admission to orthopaedic wards from ED (< 4 h) and optimal timing for surgery within 36 h, is linked with good patient outcomes. This study aims to identify factors that influence achievement of timely admission of elderly hip fracture patients to specialist wards at a UK tertiary centre. Additionally, it seeks to examine the impact of timely admission on 30-day mortality.

This retrospective, single-centre study of a cohort of 6,170 patients aged over 60 who were admitted to our hospital’s ED with hip fractures from 22/10/2015 to 02/06/2023. Patient characteristics tables were generated with patients being categorised into early ( < = 4 h) and delayed admissions (> 4 h), and then by 30-day mortality. Logistic regression analyses were performed to identify factors associated with delayed admission to specialist wards and to assess the independent effect of admission delay (over 4 h) on 30-day mortality.

Out of 5937 patients for whom admission data were available, 19% (1131/5937) were admitted within 4 h. Results showed that lower AMT score (OR 0.98, 95% CI: 0.96-1.00, p = 0.014), out-of-hours presentation (OR 1.27, 95% CI: 1.11–1.45, p < 0.001), and a higher Charlson Comorbidity Index (OR 1.05, 95% CI: 1.02–1.09, p = 0.003) were associated with an increased chance of admission delays exceeding 4 h. Furthermore, admission delays of more than 4 h (OR 1.44, 95% CI: 1.06–1.95, p = 0.02) were associated with increased 30-day mortality, controlling for the other risk factors.

Timely admission of hip fracture patients over the age of 60 is critical to reduce 30-day mortality. Low AMT score, out-of-hours presentation, and multiple comorbidities impact the timeliness of admissions in our hospital, highlighting a need to address these factors to improve care for this population.