Delay to surgery beyond 12 hours is associated with increased hip fracture mortality

Time to surgery from admission is one of the few variables known to influence outcome after a hip fracture. We reviewed our hip fracture database to determine correlation between delays to surgery and mortality in our elderly hip fracture population.

Data on all hip fracture patients admitted to a large district hospital were prospectively collected between January 1989 and August 2021. Time of the injury, time of admission and time of surgery were recorded. Patients over 60 years old with a hip fracture requiring operative management were included. Patients with pathological fractures, those managed conservatively, and patients delayed for medical reasons were excluded. Surgical timing categories were divided into; under 12 h, 12-24 h, 24-72 h and over 72 h.

Time from admission to surgery was recorded for 10,659 patients, of these time of fall was available for 10,346 patients. Mean age was 82.2 years (sd 8.39) for the cohort and 30 day mortality was 6.20%. Odds of 30-day mortality was 1.43 (CI 1.057-1.988, p = 0.025) for delay to surgery from admission of over 12 h compared to under 12 h. Odds ratios for 30-day mortality were not significant at any other time threshold. The odds of 30-day mortality for delay to surgery from time of fall were 1.550 (CI 1.026-2.459, p = 0.048) at the 12 h threshold.

This is the largest prospective study to date in elderly patients with hip fractures demonstrating a statistically significant increase in 30-day mortality with a delay to surgery over 12 h.