title: The effects of time-to-surgery on mortality and morbidity in patients following hip fracture.
abstract: OBJECTIVE
  There is a perception that the standard of care is to repair hip fractures surgically within 24 hours of hospitalization. However, it is unclear whether this reduces mortality or morbidity.
  
  
  METHODS
  We performed a retrospective study in consecutive hip fracture patients, aged 60 years or older, who underwent surgical repair. Patients with metastatic cancer, trauma, or a fracture occurring >48 hours before admission were excluded. The primary outcome was long-term (up to 18 years) mortality. Secondary outcomes included 30-day mortality and decubitus ulcers, serious bacterial infections, myocardial infarction, and thromboembolism. Analyses were adjusted for medical conditions; the comparison group comprised patients who underwent surgery for hip fracture repair within 24 to 48 hours because there were no patients with active medical problems who underwent surgery within 24 hours.
  
  
  RESULTS
  Of the 8383 patients, surgery was delayed for more than 24 hours in 2464 patients (29%) for medical reasons and in 1341 patients (16%) without active medical problems. Compared with those who underwent surgery 24 to 48 hours after admission to the hospital, patients who underwent surgery more than 96 hours after admission did not have increased long-term mortality (hazard ratio = 1.07; 95% confidence interval [CI]: 0.95 to 1.21), although the risk of decubitus ulcer was increased (odds ratio = 2.2; 95% CI: 1.6 to 3.1). There were no associations between time-to-surgery and the other secondary outcomes.
  
  
  CONCLUSIONS
  Time-to-surgery in hip fracture patients was not associated with short- or long-term mortality after adjusting for active medical problems. Other than increasing the risk of decubitus ulcer formation, waiting did not appear to affect patients' outcomes adversely.
authors.affiliation: Division of General Internal Medicine, University of Medicine and Dentistry, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.
authors.forename: Julia P
authors.initials: JP
authors.lastname: Grimes
authors.forename: Patrice M
authors.initials: PM
authors.lastname: Gregory
authors.forename: Helaine
authors.initials: H
authors.lastname: Noveck
authors.forename: Mark S
authors.initials: MS
authors.lastname: Butler
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000209:etiology; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D003668:Pressure Ulcer / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome