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Isolated hip fracture in the elderly and time to surgery: is there an outcome difference?
  1. Adel Elkbuli1,
  2. Alyssa Eily1,
  3. Valerie Polcz1,
  4. Dessy Boneva1,2,
  5. Paul J Spano II1,
  6. Mark McKenney1,2,
  7. Shaikh Hai1
  1. 1 Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
  2. 2 Department of Surgery, University of South Florida, Tampa, FL, USA
  1. Correspondence to Dr Adel Elkbuli, Department of Surgery, Kendall Regional Medical Center, Miami, FL 33175-3599, USA; Adel.elkbuli{at}


Background Early operative intervention for hip fractures in the elderly is advised to reduce mortality and morbidity. Postoperative complications impose a significant burden on patient outcomes and cost of medical care. Our aim was to determine the relationship between time to surgery and postoperative complications/mortality in patients with hip fracture.

Methods This is a retrospective review of data collected from our institution’s trauma registry for patients ≥65 years old with isolated hip fracture and subsequent surgery from 2015 to 2017. Patients were stratified into two groups based on time to surgery after admission: group 1: <48 hours versus group 2: >48 hours. Demographic variables included age, gender, race, and Injury Severity Score (ISS). The outcome variables included intensive care unit length of stay (ICU-LOS), deep venous thrombosis (DVT), pulmonary embolism (PE) rate , mortality, and 30-day readmission rates. Analysis of variance was used for analysis, with significance defined as a p value <0.05.

Results A total of 485 patients with isolated hip fracture required surgical intervention. Of those, 460 had surgery <48 hours and 25 had surgery >48 hours postadmission. The average ISS was the same in both groups. The average ICU-LOS was significantly higher in the >48 hours group compared with the <48 hours group (4.0 vs. 2.0, p<0.0002). There was no statistically significant difference between groups when comparing DVTand PE rate, 30-day readmission, or mortality rates.

Discussion Time to surgery may affect overall ICU-LOS in patients with hip fracture requiring surgical intervention. Time to surgery does not affect complication rates, 30-day readmission, or mortality. Future research should investigate long-term outcomes such as functional status and disability-adjusted life years.

Level of evidence III. Retrospective/ prognostic cohort study

  • trauma outcomes
  • trauma mortality
  • isolated hip fracture (IHF)
  • intensive care unit length of stay (ICU-LOS)

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  • Presented at The abstract leading to this article was presented at the American Association for the Surgery of Trauma (AAST) and World Trauma Congress (WTC) 2018 Annual Meeting in San Diego, California.

  • Contributors Study conception and design: AdE, DB, SH, MM, AlE, VP. Acquisition of data: AE, MM, DB, SH. Analysis and interpretation of data: AdE, AlE, SH, DB, VP, MM, PJS. Drafting of article: AdE, DB, AlE, VP, PJS. Critical revision: AdE, SH, DB, MM, AlE, VP, PJS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA or any of its affiliated entities.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This research was conducted in compliance with ethical standards and received institutional review approval.

  • Provenance and peer review Commissioned; externally peer reviewed.

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