CORR Insights®: Is Delayed Time to Surgery Associated with Increased Short-term Complications in Patients with Pathologic Hip Fractures?

Abstract

Because so many patients with cancer now are living longer as a result of targeted systemic therapies [4], skeletal metastases [7] and the pathological fractures they cause—especially to the hip—should force us to focus on how to improve the care of patients with this problem. In the current study, Varady and colleagues [18] do exactly this; they found that taking the time to medically prepare such complex patients for surgery does not compromise their postoperative outcomes in terms of surgical complications and perioperative mortality. This may be different than what we (think we) know about patients with osteoporotic hip fractures; studies suggest that delayed surgery in those patients is associated with a greater risk of complications and death [11], but whether that delay causes the excess complications remains controversial. However, what is most striking is that Varady and colleagues [18] have shown that the presence of disseminated disease is associated with increased morbidity and mortality. In other words, patients with disseminated disease are high-risk surgical fixation patients and prophylactic fixation is likely to be safer for them. Although one can say this is intuitive, it does bring to light the imperative of identifying patients at risk for fracture, as surgery is safer for those undergoing prophylactic fixation compared to undergoing fixation after a fracture has occurred [15]. Based on this, healthcare systems can introduce policies that prioritize patients with cancer and disseminated disease into screening programs to identify fractures before they occur.