Surgical delay is not associated with increased mortality in Greenlandic hip fracture patients: a 5-year...

Hip fractures are associated with increased morbidity and mortality. Guidelines recommend surgery within 24 h, but Greenland's vast geography and Arctic weather often delay surgical treatment. Our aims were (1) to describe the time until surgery among hip fracture patients in Greenland and (2) to evaluate its association with 30-day and 1-year mortality. All patients with hip fracture ICD-10 codes DS720, DS721 and DS722 from 2018 through 2022 were included. Data on time of diagnosis, time to operation, reason for delay, ASA score, Charlson Comorbidity Index (CCI), and time of death were collected from patient records. Crude and adjusted analyses were performed. Among 262 patients, the mean time to surgery was 91.4 h, and more than 24 h delay occurred in 90% of them. Mortality did not increase with surgical delay (30 days, OR = 1.0, 95% CI 0.8-1.1; 1 year, OR = 0.9, 0.8-1.1). Mortality rates were comparable to a parallel Danish cohort (30-day mortality of 9.9% vs 10.8% and 1-year mortality of 29.4% vs 28%), with distinctly shorter delays. Mortality was raised with a worse ASA score 3 (OR = 3.8, 1.9-7.4; p < 0.001) and CCI (OR = 3.1, 1.6-5.9; p = 0.001), and with age >70 years (OR = 2.5, 95% CI 1.1-5.9; p = 0.032). The constraint of vast distances and harsh weather in the Arctic causes long surgical delays in hip fracture patients, yet the inability to meet the surgical timeline recommended did not adversely affect mortality in hip fracture patients in Greenland. This questions a general need for fast-track surgery in resource-limited areas.