Delays in Hip Fracture Surgery in Geriatric Patients: A Case Series Unraveling the Contributing Factors

Context: Early surgery for hip fractures in the elderly reduces morbidity, mortality, and complications. While several factors contributing to surgical delays have been identified, further evaluation is needed to prevent them. Aims: To assess both patient and hospital-related factors influencing surgical delays in hip fracture patients aged ≥60 years. Settings and Design: Prospective and observational study at Level II trauma center. Methods: This case series includes 206 consecutive geriatric patients with hip fractures scheduled for surgery and factors contributing to surgical delays (defined as a gap of more than 48 h from hospital admission to surgery) were identified, categorized, and analysed. The significant factors were then compared with the existing literature to offer further insights into potential areas for improvement and to explore the possible explanations for the observed outcomes. Statistical Analysis Used: Unpaired t -test and Chi-square test. Results: Out of 206 patients, 44.7% (92) experienced surgical delays. Timely surgery was more likely in patients without preexisting comorbidities (71.8% of 39) and American Society of Anesthesiologists-2 patients (80% of 35). Use of anticoagulants, uncontrolled diabetes, electrolyte imbalances, anemia, urinary tract infection, and delay from the hospital’s side due to weekend admissions and referrals for surgical fitness were the major contributory factors. Conclusions: Only about half of the admitted patients received surgical intervention within 48 h of admission. Some guidelines are published for the early assessment and prompt optimization of the patients, but we still lack the Indian national guidelines to enforce the faster optimization of elderly hip fracture patients for surgery.