Time to Surgery and Thirty-Day Complications Following Hip Fracture – Is Time of the Essence?

Purpose:

While current practice guidelines emphasize expedient surgical fixation of hip fractures, the impact of time to surgery is poorly quantified. The aim of the present study was to evaluate the effect of time to surgery on major and minor complications following fixation of hip fractures.

Methods:

Utilizing the American College of Surgeons’ (NSQIP) database, we analyzed all hip fractures (femoral neck, inter-trochanteric, sub-trochanteric) treated from 2011 to 2014 inclusively. We divided patients into 4 groups based on time to surgery: 0 days (<24h), 1 day (24 to

Results:

A total of 23,044 patients underwent surgical fixation of a hip fracture and were included in our analysis. There were 5,233 (21.7%) treated <24h, 12,502 (51.9%) treated 24-48h, 4,108 (17.1%) treated 48-72h and 1,201 (5%) treated 72-96h. Thirty-day major and minor complication rates were 13.5% and 7.1% for the

Conclusion:

Despite contemporary management of hip factures, thirty-day perioperative complications are high (13.9% major and 6.7% minor complications). In this study, the majority of patients underwent surgery within 48h of hospital admission reflecting the recommendations of current practice guidelines. Furthermore, there was no significant difference in either major or minor complications between groups.. These findings suggest that current delays to surgery are largely driven by appropriate patient optimization rather than inaccessibility to the operating room.