title: Mortality after proximal femur fracture with a delay of surgery of more than 48 h.
abstract: OBJECTIVE
  For hip fractures, guidelines require surgery as soon as possible, but not later than 48 h. Some authors observed a positive and some a negative effect of early operation on mortality rate. The aim was to evaluate the mortality rate of patients with a delay of surgery >48 h after admission, as well as influencing factors and reasons for delay.
  
  
  METHODS
  One hundred and thirty-six patients with hip fractures (>65a) from 2007 to 2011 were included. Comorbidities, the American Society of Anaesthesiologists (ASA) classification, time of admission and surgery, and mortality were recorded up to 12 months. Reasons for delay were divided into administrative-related or patient-related. The following time intervals were observed: 48.01-72 h (2-3 days), 72.01-120 h (3-5 days), 120.01-168 h (5-7 days), 168 h (>7 days).
  
  
  RESULTS
  94.9 % of the reasons for delay were patient-related. The mean survival times of the first three intervals were almost the same (9.5-9.9 months) (p = 0.75). The last group had a significantly shorter survival time (7.8 months). Summarizing the first three groups, a significant shorter (p = 0.03) survival time and significantly higher (p = 0.04) 12-month mortality rate in patients with a delay >7 days was observed. The probability of death was primarily dependent on the ASA classification (p < 0.0001) and secondarily on the patient's age at the time of injury (p = 0.005).
  
  
  CONCLUSIONS
  In hip fractures, reasons for a delay >48 h are mainly patient-related. A delay up to 7 days did not influence survival time and mortality negatively. The higher the value of the ASA classification and the older the patient was at the time of injury, the higher the mortality rate and the shorter the survival time.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Johannes-Gutenberg-University of Mainz, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany. mmuhm@westpfalz-klinikum.de.
authors.forename: M
authors.initials: M
authors.lastname: Muhm
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Johannes-Gutenberg-University of Mainz, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Klein
authors.affiliation: Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Johannes-Gutenberg-University of Mainz, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Ruffing
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Johannes-Gutenberg-University of Mainz, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Winkler
keywords: Delay of surgery; Femur fracture; Hip fractures; Survival time
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