title: Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis.
abstract: BACKGROUND
  Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture.
  
  
  METHODS
  We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method.
  
  
  RESULTS
  We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68-0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34-0.69, p < 0.001).
  
  
  CONCLUSIONS
  Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMasterUniversity, Hamilton, Ontario, Canada. simunon@mcmaster.ca
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Sheila
authors.initials: S
authors.lastname: Sprague
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Emil
authors.initials: E
authors.lastname: Schemitsch
authors.forename: Justin
authors.initials: J
authors.lastname: Debeer
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D003428:Cross Infection / Q000209:etiology; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D003668:Pressure Ulcer / Q000209:etiology; D016016:Proportional Hazards Models; D012306:Risk; D012308:Risk Management; D013997:Time Factors; D016896:Treatment Outcome