title: Theatre within 36 h for patients with fracture of the proximal femur: can we deliver?
abstract: BACKGROUND
  Proximal femur fractures carry significant levels of morbidity and mortality. Surgical delay is one factor that adversely affects outcome in these patients. In 2010, hospital-income from patients with proximal femur fractures was linked to the surgery being undertaken within 36 h of admission. Can we deliver this target?
  
  
  METHODS
  Data from the 2009 National Hip Fracture Database was interrogated and appropriate patients were identified. Patient records were reviewed to identify the reasons for surgical delay. Mortality rates were compared within 36 h and after.
  
  
  RESULTS
  Five-hundred and thirty-two patients were admitted in 2009, 118 (22 %) of them were delayed more than 36 h. Surgery was delayed for a variety of identified reasons. Median time to surgery was 24 h (1-273). Ninety-day mortality for patients treated within 36 h was 12.4 %, but 25 % (P = 0.047) in patients delayed for medical problems.
  
  
  CONCLUSIONS
  Not all patients with a fracture of the proximal femur can have surgery within 36 h of their injury. However, we have identified and describe four specific areas that could increase the number of patients who meet this target.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, Warwickshire, UK. chill295@doctors.net.uk
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Hill
authors.forename: Iestyn M
authors.initials: IM
authors.lastname: Shapey
authors.forename: Filo
authors.initials: F
authors.lastname: Eales
authors.forename: Gail
authors.initials: G
authors.lastname: Mckloskey
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008485:Medical Audit; D019300:Medical Errors; D008875:Middle Aged; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult