title: Efficacy of early surgery and causes of surgical delay in patients with hip fracture.
abstract: BACKGROUND
  Whether early surgery for hip fractures is effective remains controversial. The current Japanese medical system poses some constraints on conducting early surgery. We examined the usefulness of early surgery and factors that delay surgery in patients with hip fractures treated at our hospital.
  
  
  METHODS
  Among 314 patients aged ≥60 years treated for hip fractures since January 2006, 270 patients (55 men, 215 women; mean age 84.1 years; femoral neck fracture in 111, trochanteric fracture in 159) who underwent surgery were studied. They were divided into an early surgery group (surgery up to 1 day after admission) and a delayed surgery group (later than 1 day). Clinical parameters analyzed included age, gender, pre-injury residence, pre-injury ambulatory ability, admission during public holiday, fracture site, fracture type, blood tests and urinalysis at admission, chest radiography, electrocardiography, number of systemic chronic diseases, dementia, surgical modality, blood transfusion, length of hospital stay, ambulatory ability at discharge, and hospital death. After performing univariate analysis between two groups, the parameters that were identified as significant were further tested by multivariate analysis.
  
  
  RESULTS
  Among 270 patients treated for hip fracture, 112 patients (41.5%) received early surgery. Multivariate analysis identified admission during public holiday, electrocardiographic abnormalities, femoral head replacement, and length of hospital stay as significant independent factors.
  
  
  CONCLUSIONS
  The causes of surgical delay were admission during public holiday, electrocardiographic abnormalities, and femoral head replacement. Although length of hospital stay was shorter in patients with early surgery, there was no difference in outcome.
authors.affiliation: Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hagino
authors.affiliation: Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ochiai
authors.affiliation: Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Senga
authors.affiliation: Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Wako
authors.affiliation: Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ando
authors.affiliation: Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Haro
keywords: Hip fracture; Mortality; Surgical delay