title: Do delays in surgery affect outcomes in patients with inter-trochanteric fractures?
abstract: OBJECTIVE
  To study the differences in outcomes of early versus delayed surgery in patients with intertrochanteric fractures.
  
  
  METHODS
  The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients who underwent surgery for intertrochanteric hip fractures from 2005 to 2010. A gap of >48hours between the event and the surgery was considered a delayed procedure and its impact on outcome was assessed.
  
  
  RESULTS
  Of the 190 patients, 138(72.6%) were in the early group and 52(27.3%) in the delayed group. The most common cause for delay of surgery was electrolyte imbalance in 14(27%) patients. Patients with delayed surgery had more comorbidites and higher ASA grades compared to those that underwent early surgery (p<0.05). Inpatient mortality was significantly higher in the delayed group (p=0.006). Multivariate analysis showed that higher mortality was associated with delay in surgery.
  
  
  CONCLUSIONS
  In patients with multiple comorbid conditions, expedited optimisation for surgery may be warranted to reduce mortality.
authors.affiliation: Trauma outcomes Research fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Adil Aijaz
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Aga Khan Medical University Hospital, Karachi, Pakistan.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Medical Student, Aga Khan Medical University Hospital, Karachi, Pakistan.
authors.forename: Amarah
authors.initials: A
authors.lastname: Shakoor
authors.affiliation: Department of Surgery, Aga Khan Medical University Hospital, Karachi, Pakistan.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Haroon
authors.affiliation: Department of Orthopedic Surgery, Aga Khan Medical University Hospital, Karachi, Pakistan.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Noordin
keywords: Intertrochanteric fracture, Comorbid conditions, Early group, Delayed group, Mortality.