Surgical delay beyond 72 hours was an independent risk factor for mortality in elderly patients with hip fractures, increasing the odds of death by 2.1 times compared to surgery within 72 hours.
Cohort (n=314)
No
Does surgical delay beyond 72 hours increase mortality in elderly patients with proximal femoral fractures?
In elderly patients with hip fractures, surgical delay beyond 72 hours is a significant independent predictor of increased 3-month and 1-year mortality.
Odds Ratio: 2.1 (95% CI 1.3–3.4)
Absolute Event Rate: 21.2% vs 9.2%
p-value: p=0.018
To evaluate the impact of surgical timing on mortality and functional outcomes in elderly patients with proximal femoral fractures (PFFs), specifically investigating whether a 72-h threshold provides a more sensitive clinical discriminator than the traditional 48-h guideline. A retrospective cohort study was conducted on 314 patients aged ≥ 65 years surgically treated for low-energy PFF (AO/OTA 31-A and B) between January 2018 and December 2019. Patients were initially dichotomized by a 48-h threshold (Group A ≤ 48 h, n = 139; Group B > 48 h, n = 175) and subsequently analyzed using a 72-h cutoff. Primary endpoints were 3-month and 1-year mortality. Multivariate logistic regression was performed to adjust for age, sex, and Charlson Comorbidity Index (CCI). Secondary outcomes included postoperative length of stay (LOS), transfusion requirements, and functional recovery assessed via the Barthel Index. No statistically significant difference in 3-month mortality was observed using the 48-h cutoff (Group A: 11.6% vs. Group B: 12.3%; p > 0.05). Conversely, the 72-h threshold emerged as a significant independent predictor of mortality (p 72 h as an independent risk factor (OR 2.1; 95% CI 1.3-3.4). The highest risk was observed in males aged > 85 years with extracapsular fractures operated beyond 72 h (1-year mortality: 37.5%). Mean LOS was significantly shorter in the early surgery group (7.6 ± 2.1 vs. 8.4 ± 2.8 days; p = 0.044). No significant differences were found in 3-month functional recovery between groups. In a real-world clinical setting, the 72-h threshold represents a critical "red line" for survival in elderly hip fracture patients. While striving for stabilization within 48 h remains ideal, maximum priority should be shifted toward preventing organizational delays that push vulnerable patients, particularly elderly males with extracapsular patterns, beyond the third day.Level of evidence: Level III (Retrospective cohort study).
Vadalà et al. (Sun,) conducted a cohort in Proximal femoral fractures (PFFs) (n=314). Surgical delay > 72 hours vs. Surgical delay ≤ 72 hours was evaluated on 3-month mortality (OR 2.1, 95% CI 1.3-3.4, p=0.018). Surgical delay beyond 72 hours was an independent risk factor for mortality in elderly patients with hip fractures, increasing the odds of death by 2.1 times compared to surgery within 72 hours.