Association of the time from injury to surgery with postoperative acute cardiovascular or cerebrovascular events in older patients with hip fracture: a retrospective cohort study

This study aimed to assess whether the time from injury to surgery is associated with the increased risk of postoperative acute cardiovascular or cerebrovascular events (ACVEs) in elderly hip fracture patients, given the current lack of evidence on this potentially modifiable factor. This retrospective cohort study included patients aged 60 years or older with hip fracture admitted to a tertiary referral medical center between January 2022 and December 2024. The outcome was cardiovascular or cerebrovascular events occurring within 30 days after surgery, as confirmed by medical record review. Patient demographics, comorbidities, preoperative clinical, imaging, and laboratory data were collected. A restricted cubic spline model was used to explore the nonlinear relationship between the time from injury to surgery and ACVEs, and the inflection point was defined as the time at which the odds ratio equaled 1.0, whereby patients were classified into early or late surgery group. Multivariable logistic regression was used to assess the association, adjusting for relevant confounders. Among 1083 patients included, 63 (5.8%) patients experienced acute cardiovascular or cerebrovascular events postoperatively. The inflection point was identified as 1.87 days and rounded to 2 days. Compared with the early surgery group ( n = 54), patients undergoing late surgery ( n = 1,029) had a significantly lower risk of adverse events (OR, 0.338; 95% CI, 0.135–0.842). Other significant predictors included older age, history of cerebral infarction, history of cerebral hemorrhage, and surgery type (hip arthroplasty). Early surgery (interval < 2 days) was associated with a higher risk of ACVEs in older patients with hip fracture. These findings may inform perioperative risk stratification and surgical timing decisions.