title: The effects of time-to-surgery on mortality in elderly patients following hip fractures.
abstract: BACKGROUND
  Mortality occurring as a consequence of hip fracture in older patients is very high. Mortality is highest in the first few months after the injury, and this rate is kept at a high level within the first six months postoperatively. Current guidelines indicate that surgery should be performed within 48 hours of injury because early surgery is associated with lower rates of perioperative complications and mortality.
  
  
  OBJECTIVE
  To analyse the effects of time-to-surgery on mortality in elderly patients with hip fracture.
  
  
  METHODS
  The research was conducted at the University Traumatology Clinic in Skopje, where 120 patients with hip fracture of age 65 and above were treated. The age span was 55-95 years, with a mean age of 73.9±9.8 years. The time frame for the research and the follow-up of the patients was 6 months. Inclusion criteria included patients aged above 65 and isolated proximal femur fractures. Survival time for patients after six months was determined with the Kaplan-Meier product-limit method. Statistical significance was evaluated at level of p<0.05.
  
  
  RESULTS
  The mean time from patient admission to surgical intervention was 3.07±1.5 days (range 0-6 days). Hospitalization time averaged 11±4.7 days. We separated our patient population into two groups, one consisting of patients operated in the first two days, the other after two days. The patient death rate in the first group of 25 patients operated in the first 48 hours was a total of 4 patients (16%) after 6 months. The second group, 95 patients operated after 48 hours, showed a significant rise in mortality--32 patients (33.7%). The mean survival time of patients operated within 48 hours is 168.8 days, while the mean survival time of patients operated after 48 hours from their hospital admission was 143.6 days.
  
  
  CONCLUSIONS
  Delay in surgery is associated with significant increase in mortality. Patients should have their operation as soon as possible after admission to hospital, preferably in the first 48 hours.
authors.affiliation: University Traumatology Clinic, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
authors.forename: Simon
authors.initials: S
authors.lastname: Trpeski
authors.forename: Igor
authors.initials: I
authors.lastname: Kaftandziev
authors.forename: Aleko
authors.initials: A
authors.lastname: Kjaev
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000401:mortality*; D010343:Patient Admission; D011446:Prospective Studies; D018843:Republic of North Macedonia / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome