Is it a matter of time? The effect of transfer time on femur fracture outcomes

Abstract

Background Trauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.Methods We conducted a retrospective review ofall trauma patients transferred to our level 1 rural trauma center betweenMay 1, 2016-April 30, 2019. Patient demographics and outcomes were abstractedfrom chart and trauma registry review. All patients with femur fractures wereidentified. Transfer time was defined as the time from admission at the initialhospital to admission at the trauma center, and time to repair was defined astime from admission to the trauma center until operative start time. Our outcome variables were mortality,in-hospital complications, and hospital length of stay (LOS).Results Over the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.Discussion Fixation delay greater than 24 hoursassociated with increased likelihood of in-hospitalcomplications, longer length of stay,and decreased likelihood of dischargehome. Transfertime not related to patient outcomes or time tofemur fixation.Level of evidence Level III; therapeutic/care management.