Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey

Objective. To estimate the impact of delays in surgery for hip fracture on short- and long-term outcomes. Design. Analysis of inpatient hospital data integrated with national health plan data and Central Bureau Statistics. Setting. Seven major tertiary hospitals. Patients. All consecutive elderly patients admitted with hip fracture during the years 2001-2005. Main outcome measures. Time from the hospitalization to operation; one-year mortality. Main results. Study population comprise 4633 patients, older than 65 years. The conservative approach was chosen in 818 patients (17.7%), while 1350 patients (29.1%) waited >2 days from admission to the surgery. There was a substantial variation in median pre-operative stay among the hospitals (range 0-4 days). Patients who had surgery within 2 days had lower mortality (in-hospital, 1-month and 1-year) compared to those who waited for surgery >4 days (2.9%, 4.0%, 17.4% vs. 4.6%, 6.1%, 26.2%, respectively). A Cox proportional regression model of 1-year mortality in operated patients adjusted for background morbidity (Charlson index) showed that the length of operation delay has a gradual effect on increasing mortality (<2 days - reference group, 2-4 days - OR = 1.20, 5 days or longer, OR = 1.50). The 818 (17.7%) non-operated patients suffered the highest 1-year mortality, 36.2%. Conclusions. Delays in surgery for hip fracture are associated with significant increase in short-term and 1-year mortality. Variation among the hospitals was substantial and calls for prompt quality improvement actions.