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

OBJECTIVES

To evaluate the effect of obtaining consent from a healthcare proxy on time to surgery in older adult patients with hip fracture.

DESIGN

Retrospective cohort study.

SETTING

Single Level 1 Trauma Center.

PATIENTS: 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.

INTERVENTION: Surgical consent forms were evaluated to categorize patients as self-consented (SC) or healthcare proxy-consented (HCPC).

OUTCOME MEASURES: Time of presentation-to-surgery (PTS-time) and time of admission-to-surgery (ATS-time).

RESULTS

The HCPC group had a significantly longer PTS-time compared with the SC group (median 27.1 hours vs. 22.2 hours, P = 0.036) and no significant difference in ATS-time (median 21.6 hours vs. 17.1 hours, P = 0.077). Weekend admissions and higher Frailty Index correlated with longer PTS- (ρ = 0.268, P < 0.001 and ρ = 0.252, P = 0.001, respectively) and ATS-time (ρ = 0.268, P < 0.001 and ρ = 0.198, P = 0.007, respectively). Adjusted for these variables, there was no significant difference between SC and HCPC groups in PTS-time (P = 0.996) or ATS-time (P = 1.000). In HCPC patients, postoperative delirium (OR 5.98, P = 0.002) and a hospital length of stay over 5 days (OR 2.17, P = 0.008) were more common.

CONCLUSIONS

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.

LEVEL OF EVIDENCE: III.