title: Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System.
abstract: BACKGROUND
  While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.
  
  
  METHODS
  A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.
  
  
  RESULTS
  Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.
  
  
  CONCLUSIONS
  Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.
authors.affiliation: Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Librero
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.forename: Edith
authors.initials: E
authors.lastname: Leutscher
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal-Delgado
authors.forename: Manuel
authors.initials: M
authors.lastname: Ridao
authors.forename: Natalia
authors.initials: N
authors.lastname: Martínez-Lizaga
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sanfélix-Gimeno
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D013222:State Medicine / Q000706:statistics & numerical data; D013997:Time Factors