Key result
Early surgery shows no added infection or wound healing risk versus delayed surgery in stress-induced hyperglycemia.
Why the study?
It was unclear whether stress-induced hyperglycemia affects postoperative outcomes in hip fracture patients with normal HbA1c levels, and whether delaying surgery for blood glucose normalization is necessary.
Does early surgery (< 24 h) prevent postoperative infection or delayed wound healing compared to delayed surgery in elderly hip-fracture patients with stress-induced hyperglycemia and normal HbA1c?
Cohort (n=212)
Yes
Does early surgery (< 24 h) prevent postoperative infection or delayed wound healing compared to delayed surgery in elderly hip-fracture patients with stress-induced hyperglycemia and normal HbA1c?
In elderly hip fracture patients with stress-induced hyperglycemia but normal HbA1c, delaying surgery to normalize blood glucose does not improve postoperative outcomes and is unnecessary.
Answers are grounded in this paper and cite their sources.
Early surgery timing was not linked to infection in this cohort; leaves open optimal hip fracture management pending randomized trials.
BACKGROUND: To investigate whether stress-induced hyperglycemia influences postoperative outcomes in hip fracture patients with normal hemoglobin A1c (HbA1c) levels, and to determine if delaying surgery for blood glucose normalization is necessary. METHODS: This multicentre retrospective cohort (August 2017 – November 2022) included 212 patients (≥ 60 years) with femoral-neck or intertrochanteric fractures and admission random glucose ≥ 11.1 mmol/L. Patients were classified as early surgery (< 24 h from admission; median 18 h) or delayed surgery (≥ 24 h; median 38 h) after fasting glucose was reduced to 7.0–8.0 mmol/L. Primary outcomes were postoperative infection and delayed wound healing (failure to heal within 14 days). Secondary outcomes were Harris Hip Score (HHS) at 12 months and 24-h Visual Analogue Scale (VAS) pain. Multivariable logistic and linear regression adjusted for age, gender, body mass index (BMI), diabetes, hypertension, operative time, American Society of Anesthesiologists (ASA) classification and surgery type. RESULTS: Early surgery was not associated with higher infection risk (adjusted odds ratio [aOR] = 1.22, 95% CI 0.91–1.64) or delayed wound healing (aOR = 0.99, 95% CI 0.23–4.31). It had no significant impact on hip function (β = − 1.05, 95% CI − 1.99 to 0.12) or VAS pain (β = − 0.08, 95% CI − 0.42 to 0.27). BMI independently predicted outcomes: each 1 kg/m² increase raised infection risk by 16% (aOR = 1.16, 95% CI 1.07–1.26) but lowered the likelihood of delayed healing (aOR = 0.75, 95% CI 0.62–0.91). CONCLUSION: In hip fracture patients with stress-induced hyperglycemia but normal HbA1c levels, delaying surgery for blood glucose normalization does not significantly impact postoperative outcomes. Therefore, surgery should not be postponed solely due to elevated blood glucose levels. Emphasizing the long-term optimization of nutritional status and weight maintenance may reduce postoperative infections and improve functional recovery.
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Xie et al. (2025) conducted a cohort in Hip fracture with stress-induced hyperglycemia (n=212). Early surgery (< 24 hours) vs. Delayed surgery (≥ 24 hours) was evaluated on Postoperative infection (aOR 1.22, 95% CI 0.91-1.64). Early surgery (<24h) did not increase postoperative infection (aOR 1.22) or delayed wound healing versus delayed surgery in hip fracture patients with stress-induced hyperglycemia and normal HbA1c.
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