Does delaying surgery for “healthy” hip fracture patients have increased complications and mortality?



      Surgical delay is one of the risk factors for mortality and morbidity in patients with HF. One of the causes of delay is due to admission on Thursday-Friday, weekends, holidays or previous periods. The final objective of this study is to analyze administrative-organizational delay in complication and mortality rates.

      Material and methods

      A total of 607 cases of surgically operated hip fractures were analyzed. Two groups were established, one of them operated on in < 48 h (ND group) and the other surgically delayed for administrative organizational reasons (AA group). Demographic variables related to treatment and fracture were analyzed in both groups, as well as the rates of surgical wound complications, general complications and mortality rate in the first 30 days, in the first year and more than one year after surgery.


      We observed a surgical wound seroma and staining rate of 15.7% in the AA group and 9.6% in the ND group; and a surgical wound surface infection rate of 1.9% in the AA group and 0.8% in the ND group (p = 0.275). General complications occurred in 34.4% (AA group) and 29% (ND group). The 30-day mortality rate was 4.8% in the AA group and 1.9% in the ND group (p = 0.081).


      We found no statistically significant differences in patients delayed for administrative reasons in terms of mortality and surgical wound and general complication rates. Although the proportion of surgical wound complications and 30-day mortality was higher in the AA group versus the ND group.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • González Montalvo J.I.
        • Alarcón Alarcón T.
        • Pallardo Rodil B.
        • Gotor Pérez P.
        • Pareja Sierra T.
        Ortogeriatría en pacientes agudos (II). Aspectos clínicos.
        Rev Esp Geriatr Gerontol. 2008; 43: 316-329
        • Mesa-Lampré M.P.
        • Canales-Cortés V.
        • Castro-Vilela M.E.
        • Clerencia-Sierra M.
        Puesta en marcha de una unidad de ortogeriatría.
        Rev Esp Cir Ortop Traumatol. 2015; 59: 429-438
        • Papadimitriou N.
        • Tsilidis K.K.
        • Orfanos P.
        • Benetou V.
        • Ntzani E.E.
        • Soerjomataram I.
        • et al.
        Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium.
        Lancet Public Health. 2017; 2: e239-e246
        • Pincus D.
        • Ravi B.
        • Wasserstein D.
        • Huang A.
        • Paterson J.M.
        • Nathens A.B.
        • et al.
        Association between wait time and 30-day mortality in adults undergoing hip fracture surgery.
        JAMA J Am Med Assoc. 2017; 318: 1994-2003
        • Pincus D.
        • Wasserstein D.
        • Ravi B.
        • Huang A.
        • Paterson J.M.
        • Jenkinson R.J.
        • et al.
        Medical costs of delayed hip fracture surgery.
        J Bone Jt Surg Am Vol. 2018; 100: 1387-1396
        • Mitchell S.M.
        • Chung A.S.
        • Walker J.B.
        • Hustedt J.W.
        • Russell G.V.
        • Jones C.B.
        Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 days.
        J Orthop Trauma. 2018; 32: 629-633
        • Boylan M.R.
        • Riesgo A.M.
        • Paulino C.B.
        • Tejwani N.C.
        Day of admission is associated with variation in geriatric hip fracture care.
        J Am Acad Orthop Surg. 2019; 27: E33-E40
        • Orosz G.M.
        • Hannan E.L.
        • Magaziner J.
        • Koval K.
        • Gilbert M.
        • Aufses A.
        • et al.
        Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair.
        J Am Geriatr Soc. 2002; 50: 1336-1340
        • Pincus D.
        • Wasserstein D.
        • Ravi B.
        • Byrne J.P.
        • Huang A.
        • Paterson J.M.
        • et al.
        Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada.
        Cmaj. 2018; 190: E702-E709
        • Tanner A.
        • Jarvis S.
        • Orlando A.
        • Nwafo N.
        • Madayag R.
        • Roberts Z.
        • et al.
        A three-year retrospective multi-center study on time to surgery and mortality for isolated geriatric hip fractures.
        J Clin Orthop Trauma. 2020; 11 ([Internet]Available from:): S56-S61
        • Zeltzer J.
        • Mitchell R.J.
        • Toson B.
        • Harris I.A.
        • Close J.
        Determinants of time to surgery for patients with hip fracture.
        ANZ J Surg. 2014; 84: 633-638
        • Sayers A.
        • Whitehouse M.R.
        • Berstock J.R.
        • Harding K.A.
        • Kelly M.B.
        • Chesser T.J.
        The association between the day of the week of milestones in the care pathway of patients with hip fracture and 30-day mortality: findings from a prospective national registry - the national hip fracture database of england and wales.
        BMC Med. 2017; 15: 1-13
        • Sheikh H.Q.
        • Aqil A.
        • Hossain F.S.
        • Kapoor H.
        There is no weekend effect in hip fracture surgery – a comprehensive analysis of outcomes.
        Surgeon. 2018; 16: 259-264
        • William R.
        • Angel B.
        McAndrew christopher GMJ. factors effecting delay to surgery and length of stay for hip fracture patients.
        J Orthopetic Trauma. 2015; 29: e109-3114
        • Sánchez-Crespo M.R.
        • Bolloque R.
        • Pascual-Carra A.
        • Pérez-Aguilar M.D.
        • Rubio-Lorenzo M.
        • Alonso-Aguirre M.A.
        • et al.
        Mortalidad al año en fracturas de cadera y demora quirúrgica.
        Rev Esp Cir Ortop Traumatol. 2010; 54: 34-38
        • Cid J.
        • Moreno J.
        • Indice de B.
        Actividades básicas de la vida diaria [Internet].
        Rev Esp Salud Pública. 1997; 71 (Available from)
        • American Society of Anesthesiologists
        ASA physical status classification system.
        SELL J. 2020; 5: 1-4
        • Lizaur-Utrilla A.
        • Gonzalez-Navarro B.
        • Vizcaya-Moreno M.F.
        • Miralles Muñoz F.A.
        • Gonzalez-Parreño S.
        • Lopez-Prats F.A.
        Reasons for delaying surgery following hip fractures and its impact on one year mortality.
        Int Orthop. 2019; 43: 441-448
        • Cha Y.H.
        • Ha Y.C.
        • Yoo J.
        • Il M.Y.S.
        • Lee Y.K.
        • Koo K.H.
        Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture.
        Arch Orthop Trauma Surg. 2017; 137: 625-630