Time to surgery and its impact on length of stay and mortality for neck of femur fractures at a major trauma centre

Purpose Neck of femur (NOF) fractures are a major public health concern. Timely surgical intervention (current guidelines is within 36 h) is associated with improved survival, shorter hospital stays, and better functional outcomes. However, surgical delays remain common in hospitals, especially in major trauma centres, and their impact on length of stay (LOS) and mortality is not well defined across different NOF fracture subtypes. Methods We conducted a retrospective cohort study of 4415 patients with NOF fractures, classified into intracapsular ( n = 2507) and extracapsular ( n = 1908). The primary outcome data gathered were LOS (from surgery to discharge) and in-hospital mortality. Regression analyses were performed to assess associations between LOS, and mortality, adjusting for age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) score, intra-operative blood transfusion, and surgical methods. Results For intracapsular fractures, delays in time to surgery were significantly associated with increased LOS in patients expected to have short to median lengths of stay, after adjusting for other variables ( p < 0.05). Delayed surgery was associated with increased mortality for both intracapsular and extracapsular fractures ( p < 0.0001). Survival curves showed significant differences for the surgical delayed group. After controlling for time to surgery, ASA, CCI, intra-operative blood transfusion and surgical methods, patients ≥ 70 experienced longer LOS ( p < 0.0001). Conclusion Early surgery is associated with shorter LOS for intracapsular NOF fractures. Delayed surgery (> 36 h) significantly increases mortality risk for both intracapsular and extracapsular fractures. Patients ≥ 70 years face longer hospital stays and higher mortality, suggesting a need for targeted perioperative strategies. Our findings support prioritising high-risk patients for expedited surgery. Future work aims to develop a risk stratification tool to optimise surgical prioritisation.