title: The timing of surgery and mortality in elderly hip fractures: A retrospective, multicenteric cohort study.
abstract: BACKGROUND
  Early surgery is recommended for elderly hip fracture patients, but some studies show no clear advantage. The benefits of early surgery may differ according to the medical environment in different countries. The purpose of this study was to identify the potential benefits of early surgery in elderly hip fracture patients by evaluating the effect of timing of surgery on mortality.
  
  
  METHODS
  A retrospective study was conducted at multiple centers on hip fracture patients aged over 65 years. The primary outcome was 1 year mortality and the secondary outcomes were 30-day/6-month mortality and complications during admission. The effect of time to surgery on mortality was analyzed using a Cox proportional-hazards model.
  
  
  RESULTS
  Among the 874 patients, 162 (18.5%) received surgery within 3 days and their 1-year mortality rate was 9.9%. However, the 1-year mortality rate for the delayed surgery group was 12.5%. After adjustment for potential confounders, the 1-year mortality rates in patients who received surgery in 3-7 days (Hazard ratio = 1.0; 95% confidence interval [CI]: 0.7-1.6) and over 7 days (hazard ratio = 1.3; 95% CI: 0.9-1.8) were not significantly different. In addition, the time to surgery did not have a significant effect on 30-day mortality, 60-day mortality or complications arising during hospitalization.
  
  
  CONCLUSIONS
  The time to surgery did not affect short and long term mortality or the in hospital complication rate in elderly hip fracture patients. We recommend concentrating more on optimizing the condition of patients early with sufficient medical treatment rather than being bound by absolute timing of surgery.
authors.affiliation: Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Hyuk Joong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Departments of Emergency Medicine, CHA University, Gyeonggi-do, South Korea.
authors.forename: Euichung
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Young Jeon
authors.initials: YJ
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Bo Youl
authors.initials: BY
authors.lastname: Choi
authors.affiliation: Department of Orthopaedics, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Lim
keywords: Hip fracture; Hip fractures; Orthopedic surgery; hip surgery; morbidity; mortality