Impact of Surgical Timing on Hospital Length of Stay Following Hemiarthroplasty and Internal Fixation for Hip Fractures: A Six-Year Retrospective Cohort Study

Background: Hip fractures are a major cause of morbidity and healthcare utilization among elderly patients. Early surgical intervention has been associated with improved postoperative outcomes; however, the effect of surgical timing on hospital length of stay (LOS) remains debated, especially in the Middle Eastern region. This study aimed to evaluate the impact of surgical timing on LOS and postoperative outcomes among elderly patients undergoing hip fracture surgery. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Patients aged ≥ 60 years who underwent surgical management for proximal femur fractures between May 2019 and May 2025 were included. Surgical timing was categorized as early (<48 h from admission) or delayed (≥48 h). The primary outcome was hospital LOS. Secondary outcomes included ICU admission, venous thromboembolism (VTE), respiratory infection, periprosthetic infection, and one-year mortality. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to assess time to hospital discharge. Relative risks (RR) with 95% confidence intervals (CI) were calculated for postoperative outcomes. Results: A total of 179 patients were included, of whom 100 (55.9%) underwent early surgery, and 79 (44.1%) underwent delayed surgery. The median LOS was significantly shorter in the early surgery group compared with the delayed surgery group (7 days 95% CI: 6–7 vs. 11.5 days 95% CI: 9–14; log-rank p < 0.001). After adjustment for comorbidities, surgical factors, and pre-hospital delay, early surgery remained independently associated with earlier discharge (hazard ratio 2.17, 95% CI 1.55–3.04; p < 0.001). ICU admission occurred less frequently in the early surgery group (6.0%) compared with the delayed surgery group (17.7%) (RR 0.34, 95% CI 0.14–0.83; p = 0.013). No significant differences were observed in VTE, respiratory infection, periprosthetic infection, or one-year mortality between groups. Conclusions: Surgery performed within 48 h of admission was associated with significantly shorter hospital LOS and lower ICU admission rates among elderly patients undergoing hip fracture surgery. These findings highlight the importance of timely surgical intervention to improve perioperative efficiency and hospital resource utilization.