Surgical timing for proximal femur fractures does not affect early mortality: single center experience

Purpose: This study investigates the relationship between surgical timing and 30-day and 90-day mortality in geriatric patients with proximal femur fractures. It also evaluates other parameters potentially affecting mortality, addressing the ongoing debate in the literature about the ideal surgical timing for such fractures. Patients and methods: A retrospective analysis of 181 patients aged 65 and older with femoral neck or intertrochanteric femur fractures was conducted. Data on demographics, comorbidities, fracture type, surgical timing, and mortality were collected. Patients were categorized into four groups based on surgery timing: within 24 hours, 24-48 hours, 48-72 hours, and after 72 hours. Statistical analyses included t-tests, Mann-Whitney U tests, Chi-square tests, and Bonferroni-corrected post hoc analyses. A significance level of p<0.05 was used. Results: The overall 30-day and 90-day mortality rates were 3.86% and 11.04%, respectively. Surgical timing did not significantly affect 30-day and 90-day mortality. The highest 30-day mortality rate (6.7%) was observed in patients operated on within the first 24 hours, potentially due to rushed preoperative preparations. The group with the highest 90-day mortality rate (22%) consisted of patients undergoing surgery after 72 hours, likely influenced by comorbidities or anticoagulant use. Conclusion: Surgical timing does not significantly affect mortality in proximal femur fractures, though the safest interval appears to be 24-72 hours. While early surgery can reduce complications related to immobilization, sufficient time for preoperative optimization is crucial. A balanced approach focusing on patient readiness rather than rigid timing guidelines ensures better outcomes.