title: Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice.
abstract: BACKGROUND
  The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality.
  
  
  METHODS
  Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated.
  
  
  RESULTS
  A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ (2) (1, N = 512) = 0.10, p = 0.757].
  
  
  CONCLUSIONS
  Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable.
  
  
  METHODS
  III.
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK. a.aqil@imperial.ac.uk.
authors.forename: Adeel
authors.initials: A
authors.lastname: Aqil
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK.
authors.forename: Fahad
authors.initials: F
authors.lastname: Hossain
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK.
authors.forename: Hassaan
authors.initials: H
authors.lastname: Sheikh
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Aderinto
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK.
authors.forename: George
authors.initials: G
authors.lastname: Whitwell
authors.affiliation: Level 1 Trauma Centre, Leeds General Infirmary, Great George St, Leeds, LS1 3EX, UK.
authors.forename: Harish
authors.initials: H
authors.lastname: Kapoor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007010:Hyponatremia / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: 36 h; Hip fractures; Time to treatment