Does surgical delay time affect mortality and functional outcomes in elderly patients with hip fractures?

Introduction and Objective: Hip fracture in elderly population is a global health problem because of the high mortality and deterioration of functional status of the patients. The purpose of this study is to determine how surgical delay in elderly patients with hip fracture influences mortality and functional outcomes.
Patients and Methods: An observational and retrospective study was designed. A total of 357 patients over 70 years of age with primary hip fracture were studied. Epidemiological characteristics and comorbidities were collected. Baseline functional status was assessed based on comorbidity, dependency degree and used of assistive devices. The patients were divided into three comparison groups based on the surgical delay time from hospital admission: group A (surgery ≤ 24 h), group B (surgery 24 - 48 h), and group C (> 48 h). In-hospital mortality, 30-day after hospital discharge mortality, one-year mortality and postoperative complications were recorded. After two years of follow-up, a new clinical-functional assessment was conducted.
Results: Surgery was performed < 24 h in 79 patients (22 %), between 24 and 48 h in 88 patients (25 %), and over 48 h in 190 patients (53 %). In-hospital mortality was 3.6 %, 30-day post-discharge mortality was 4.1 %, and one-year mortality was 14.8 %. One-year mortality was lower in patients with a surgical delay of more than 48 h (HR:0.36; 95 % CI (0.14-0.91), p = 0.03). We observed the same trend for in-hospital mortality (HR:0.32; 95 % CI (0.8-1.2), p = 0.10) and 30-day mortality (HR:0.96; 95 % CI (0.19-4.83), p = 0.96). Postoperative complications were reported in 34 % of patients in group A, 49 % of patients in group B, and 47 % of patients in group C (p = 0.067). 30 % of patients in group A, 30 % of patients in group B, and 37 % of patients in group C maintained autonomous mobility inside and outside the home after surgery (p = 0.001).
Conclusion: In our study, patients with longer surgical delays presented lower one-year mortality, but no differences were found in functional outcomes and complication rates. However, these findings should be interpreted with caution due to baseline differences between treatment groups and the limitations of the study. More studies with a higher level of evidence are needed in the future.
Level of Evidence: IV.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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