Is the Timing of Surgery Associated With the Risk of Mortality Among Older Adults Undergoing Operative Hip Fracture Repair?

Introduction: Hip fractures are common among older adults; and while urgent fracture fixation is recommended, it is often weighed against preoperative optimization needs. Previous studies have reported conflicting findings on the association between time to surgery and mortality risk. In this study, we investigated the association between surgical timing and mortality. We also explored the relationship between time to surgery and secondary outcomes, including length of stay and hospital readmission. Methods: We conducted a retrospective cross-sectional study of 967 adults aged ≥ 65 who underwent hip fracture repair between 2018 and 2023. Time to surgery (in days) was the primary exposure. Multivariable Cox proportional hazards models were used to assess associations with 30-day, 90-day, and 365-day mortality. Firth penalized logistic regression was used to examine associations with secondary outcomes, including length of stay >7 days and 30-day readmission. Results: For 30-day, 90-day, and 365-day mortality, each additional day of delay in surgery was associated with an increased risk of mortality, with adjusted hazard ratios (HR) of 1.15 (95% CI [1.02, 1.30], P = .02), 1.13 (95% CI [1.02, 1.26], P = .02), and 1.09 (95% CI [1.01, 1.19], P = .03), respectively. Similarly, each additional day of delay was associated with an increased risk of a length of stay >7 days and readmission within 30 days of discharge, with adjusted odds ratios (OR) of 2.26 (95% CI [1.89, 2.74]) and 1.16 (95% CI [1.05, 1.29]), respectively. Conclusion: Delaying surgery in older adults increases the risk of mortality, along with a potential elevated risk of prolonged hospital stays and readmission. We recommend that, when safe, surgery should be performed promptly for these patients.