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Purpose <p>The aim of this study was to determine if a delay to surgery of more than 48&#xa0;h was associated with poorer functional outcomes and increased 1-year mortality rates for elderly hip fractures.</p> Methods <p>A retrospective review of surgically treated&#xa0;elderly (≥ 60&#xa0;years old) hip fracture patients in a single institution was conducted. Patients were divided into 2 groups depending on hours from admission to surgery: Group 1 ( ≤ 48&#xa0;h) and Group 2 (&gt; 48&#xa0;h); these groups were 1:1 matched for the initial Modified Barthel’s Index (MBI) and Charlson Comorbidity Index (CCI).</p> Results <p>2562 patients were eligible for the study. The cut-point value in a receiver operating curve analysis for 12-month MBI against time to surgery was not robust&#xa0;enough to determine an optimal time for surgery. Group 1 (n = 888) had significantly better MBI scores at 6-months [mean 78.7 (± 19.9) vs. mean 75.5 (± 20.6)] and 1-year [mean 80.4 (± 20.1) vs. mean 76.9 (± 22.3)] (<i>p</i> &lt; 0.001). This&#xa0;difference in MBI scores between the groups&#xa0;did not meet the minimal clinically important difference of 10 &#xa0;points. There&#xa0;was no significant difference in 1-year mortality (3.7% vs. 4.4%) (<i>p</i> = 0.427). Delayed surgery past 48&#xa0;h significantly increased the risk of post-operative complications.&#xa0;(Urinary tract infection, acute retention of urine and pneumonia) (<i>p</i> &lt; 0.001).</p> Conclusion <p>Delayed surgery for elderly hip fractures after 48&#xa0;h increases the risk of acute post-operative complications. There is no increase in 1-year mortality and no clinically important deterioration of MBI if operated on after 48&#xa0;h.</p> Level of evidence <p>III.</p>

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Does early surgery within 48 hours improve clinical outcomes in elderly hip fractures? A matched cohort study of 1776 hip fractures

  • 期刊论文

  • 发表日期：

    2025年5月18日

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  • Zachary Chu,
  • Julia Poh Hwee Ng,
  • Tjun Huat Ivan Chua,
  • Sean Wei Loong Ho

摘要

Purpose

The aim of this study was to determine if a delay to surgery of more than 48 h was associated with poorer functional outcomes and increased 1-year mortality rates for elderly hip fractures.

Methods

A retrospective review of surgically treated elderly (≥ 60 years old) hip fracture patients in a single institution was conducted. Patients were divided into 2 groups depending on hours from admission to surgery: Group 1 ( ≤ 48 h) and Group 2 (> 48 h); these groups were 1:1 matched for the initial Modified Barthel’s Index (MBI) and Charlson Comorbidity Index (CCI).

Results

2562 patients were eligible for the study. The cut-point value in a receiver operating curve analysis for 12-month MBI against time to surgery was not robust enough to determine an optimal time for surgery. Group 1 (n = 888) had significantly better MBI scores at 6-months [mean 78.7 (± 19.9) vs. mean 75.5 (± 20.6)] and 1-year [mean 80.4 (± 20.1) vs. mean 76.9 (± 22.3)] (p < 0.001). This difference in MBI scores between the groups did not meet the minimal clinically important difference of 10  points. There was no significant difference in 1-year mortality (3.7% vs. 4.4%) (p = 0.427). Delayed surgery past 48 h significantly increased the risk of post-operative complications. (Urinary tract infection, acute retention of urine and pneumonia) (p < 0.001).

Conclusion

Delayed surgery for elderly hip fractures after 48 h increases the risk of acute post-operative complications. There is no increase in 1-year mortality and no clinically important deterioration of MBI if operated on after 48 h.

Level of evidence

III.