[How does the preoperative waiting time affect hospital mortality and complication rates in geriatric patients with medial femoral neck fractures?]

Background: The current guidelines of the German Federal Joint Committee on the treatment of proximal femoral fractures require that patients with a proximal femoral fracture receive surgical treatment as soon as possible and within 24 h of admission. This is intended to reduce perioperative complication rate and mortality.

Objective: The aim of this study was to analyze the hospital mortality as well as complication rates and types in relation to the preoperative waiting time.

Methodology: From 2010 to 2020, a total of 575 patients with femoral neck fractures treated with a bipolar prosthesis were retrospectively analyzed with respect to hospital mortality and the occurrence of complications. Patients with pathological fractures, femoral neck fractures more than 4 weeks old and those treated with osteosynthesis were excluded. Patient-specific data, hospital mortality and complication rates and types were recorded.

Results: During the study period, the implementation of the given guidelines resulted in a reduction in the preoperative waiting time from a median of 38 h in 2010 to 19 h in 2020. Surgical treatment was performed on average after 14.2 h in patients who had surgery within 24 h after admission and on average after 40.2 h for those who had surgery after 24 h. The average American Society of Anesthesiologists (ASA) score for all 575 patients was 2.76. The group of patients who had surgery after more than 24 h had a significantly higher ASA classification (p = 0.024). A total of 12 (4.2%) patients in the group surgically treated within 24 h died, compared to 24 (8.5%) deaths in the group surgically treated after 24 h (p = 0.035). The complication rate for the entire cohort was 15% (88 patients). There was no difference in the occurrence of complications and the overall complication rate with respect to the timing of surgery.

Conclusion: During the study period the preoperative waiting time was halved from 39h to 19 h. Patients who were surgically treated within 24 h had a significantly lower hospital mortality than those surgically treated after 24 h; however, the group surgically treated after 24 h simultaneously showed higher baseline comorbidities and in the adjusted analysis for age and ASA score, the 24‑h threshold no longer emerged as an independent risk factor for hospital mortality. Regarding complication rates, no significant differences were found between the groups based on the timing of surgery.