Admission to operation delay was associated with all-cause mortality in patients with hip fractures: a propensity...

To evaluate the association between admission to operation (ATO) and mortality in elderly patients with hip fractures using propensity score matching (PSM).

We retrospectively collected the geriatric patients with hip fractures from 1 January 2015 to 30 September 2019 in our institution. Patients' characteristics and medical comorbidities were collected to explore the association. The primary outcome was all-cause mortality after surgery. All statistical analyses were performed using the software R and EmpowerStats.

This study included 2,360 patients, with a mean follow-up of 39.91 ± 19.05 months. Patients were divided into three groups: ATO ≤ 2d; 2d < ATO ≤ 5d; ATO > 5d. During the follow-up period, 733 (31.07%) patients died. We did not find a linear association between ATO and mortality during long-term follow-up in all patients' univariate and multivariate analyses. After 1:1 matching, 1,366 patients (57.8%) were successfully matched. Most of the successfully matched patients in the two groups had scores between 0.7 and 0.95, indicating a high level of match. The C-statistical value was 0.7083, which was at the intermediate level. ATO was linearly associated with the all-cause mortality rate in the PSM model. Each 1-day delay in ATO was associated with a 3% increase in the long-term mortality rate (HR = 1.03; 95%CI: 1.00-1.06; P = 0.0399).

ATO was associated with all-cause mortality in a linear association for patients with hip fractures. This finding underscores the critical importance of early surgical intervention for improving prognosis. Policymakers should optimize healthcare resource allocation, while healthcare institutions should minimize non-essential systemic delays to reduce mortality risk in hip fracture patients.