Impact of Surgical Timing on Mortality and Functional Outcomes in Elderly Hip Fracture Patients: a Retrospective Cohort Study.

Abstract

Background: Hip fractures among the elderly stem from low-energy trauma and frequently coincide with osteoporosis or low bone mass, along with other related medical conditions that heighten, the risk of falls with the majority of hip fractures manifest in women aged over 65 years, with an estimated global annual incidence of approximately 1.7 million. The incidence is expected to rise in tandem with increasing life expectancy and the expanding population of elderly individuals and those grappling with chronic health conditions.

Objective: The aim of this study was to assess the impact of surgical timing on mortality and functional outcomes in elderly hip fracture patients and identify systemic factors contributing to delays.

Methods: This retrospective cohort study analyzed 236 patients aged ≥50 years with surgically treated hip fractures at King Abdullah University Hospital, Jordan (2019-2022). Patients were stratified into early (≤3 days post-admission) and delayed (>3 days) surgery groups. Data on demographics, comorbidities, surgical variables, and outcomes were extracted from electronic health records. Statistical analyses included Wilcoxon rank sum, Chi-squared tests, and logistic regression to evaluate associations between surgical delay and mortality.

Results: Delayed patients (31.8%) exhibited significantly higher 1-year mortality (31% vs. 12%, p<0.001), longer hospital stays (11.2 vs. 5.9 days, p<0.001), and reduced ambulation at 3 months (36% vs. 16% non-ambulatory, p<0.001). Logistic regression identified surgical delay as an independent mortality predictor: delayed patients with ≥3 comorbidities had 9.02-fold higher odds of death (95% CI: 1.67-167.85, p=0.038), while those with <2 comorbidities had a 13.18-fold increase (95% CI: 2.27-251.18, p=0.017). Systemic barriers included preoperative ICU admissions (12% vs. 1.2%, p<0.001) and lower preoperative hemoglobin levels (11.26 vs. 11.87 g/dL, p=0.012).

Conclusion: Surgical delay beyond three days independently elevates mortality and disability risks in hip fracture patients, irrespective of comorbidities. Timely intervention mitigates comorbidity-related risks, underscoring the need for multidisciplinary pathways and policy reforms to reduce delays.