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Published on: June 6, 2025
Time to Surgery and Outcome in the Treatment of Proximal Femoral Fractures
Hanna Leicht1, Thomas Gaertner, Christian Günster
1AOK Research Institute (WIdO), Berlin; Medical Service of German Statutory Health Insurance Providers (MDK) Hessen, Oberursel; Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld/Kremmen; BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt; AOK-Bundesverband, Berlin; Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin; HELIOS Health Kliniken GmbH, Berlin.
Background:
It has not been conclusively established whether, or to what extent, the time to surgery affects mortality and the risk of complications after the surgical treatment of proximal femoral fractures.
Methods:
Data on 106 187 hospitalizations over the period 2015-2017 involving insurees of the German AOK health insurance company aged 20 and above were drawn from pseudonymized billing data and stratified in three subgroups: osteosynthesis for pertrochanteric fracture (PTF-OS: N = 52 358), osteosynthesis for femoral neck fracture (FNF-OS: N = 7970), and endoprosthesis for femoral neck fracture (FNF-EP: N = 45 859). Multivariate regression models were used to analyze the relation between preoperative in-hospital stay (time to surgery, TTS: 0 days [reference category], 1, 2, 3, 4-7 days) and mortality and general complications within 90 days, with risk adjustment for fracture site, operative method, age, sex, accompanying illnesses, and antithrombotic medication in the preceding year.
Results:
Mortality was significantly elevated only with PTF-OS, and only with a TTS of 2 days (odds ratio: 1.12 [95% confidence interval: (1.02; 1.23)]). General complications in relation to TTS were significantly elevated in the following situations: PTF-OS: 2 days: OR 1.24 [1.13; 1.37], 3 days: OR 1.33 [1.11; 1.60], 4-7 days: OR 1.47 [1.21; 1.78]; FNF-EP: 3 days: OR 1.21 [1.06; 1.37], 4-7 days: OR 1.42 [1.25; 1.62]; FNF-OS: 4-7 days: OR 1.86 [1.26; 2.73].
Conclusion:
A prolonged time to surgery is associated with an elevated general complication risk depending on the site of the fracture and the type of surgical procedure used.
