Risk Factors and Causes of Delayed Hip Fracture Surgery in Elderly Patients: Findings from a Hip Fracture Fast-Track Surgery Program

BACKGROUND: Early surgical management of hip fractures within 48 hours improves outcomes in elderly patients. Despite established fast-track surgery protocols, surgical delays continue to occur. OBJECTIVES: To determine the incidence and risk factors of delayed hip fracture surgery in elderly patients and to describe system-related and patient-related causes of surgical delay within a Hip Fast-Track (HFT) care model. METHODS: This retrospective cohort study reviewed medical records of elderly patients with hip fractures treated between October 1, 2022, and September 30, 2024. Patients were categorized into urgent surgery and delayed surgery (>48 hours after admission). Data were analyzed using descriptive and multivariable statistical methods. Causes of delay were analyzed descriptively in the delayed surgery group. RESULTS: Among 390 patients, 132 (33.85%) underwent surgery more than 48 hours after admission. Notable factors associated with delayed surgery included the presence of ≥3 comorbidities (OR = 2.34, P < 0.001), anemia or the need for preoperative blood transfusion (OR = 2.90, P < 0.001), and admission on Thursday or Friday (OR = 3.92, P < 0.001). Causes of delay included hospital-related and patient-related factors. Patients in the delayed surgery group had a longer median hospital stay and higher rates of urinary tract infection and pressure ulcers. CONCLUSION: Optimizing preoperative preparation, particularly for patients with multiple comorbidities, strengthening preoperative anemia management and blood transfusion systems, and establishing surgical service continuity during public holidays are essential to achieve timely hip fracture surgery.