Delaying Hip Fracture Surgery for 1 Day Tied to Higher Mortality Risk

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Delayed surgery for hip fracture is associated with elevated morbidity and mortality, a JAMA study finds.

Using administrative databases in Ontario, researchers studied 42,000 adults who underwent hip fracture surgery in 72 hospitals. Only a third received early surgery — that is, within 24 hours of arriving in the emergency department. Most of these early-surgery patients were matched to a similar number who had delayed surgery (after 24 hours).

The primary outcome — mortality within 30 days of admission — was higher with delayed surgery (6.5% vs. 5.8% with early surgery). Delayed surgery patients also had slightly higher rates of complications like pulmonary embolism, myocardial infarction, and pneumonia.

Editorialists conclude: “A wait time of 24 hours may represent a threshold defining higher risk. Because two-thirds of patients did not receive surgery within this timeframe, performance improvement is warranted.”