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Early Surgery Confers 1-Year Mortality Benefit in Hip-Fracture Patients

Maheshwari, Kamal, MD, MPH*,†; Planchard, Jeffrey, MD, MBA; You, Jing, MS†,‡; Sakr, Wael, Ali, MD, PhD; George, Jaiben, MBBS§; Higuera-Rueda, Carlos, A., MD§; Saager, Leif, MD, MMM*,†,‖; Turan, Alparslan, MD*,†; Kurz, Andrea, MD*,†

Journal of Orthopaedic Trauma: March 2018 - Volume 32 - Issue 3 - p 105–110
doi: 10.1097/BOT.0000000000001043
Original Article

Background: To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair.

Methods: We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors.

Results: Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02–1.08) per 10-hour delay (P = 0.001).

Conclusions: A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Departments of *Department of General Anesthesiology, and

Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH;

Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH;

§Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH; and

Department of Anesthesiology, University of Michigan, Ann Arbor, MI.

Reprints: Kamal Maheshwari, MD, Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Mail Code 9500 Euclid Avenue, Cleveland, OH 44195 (e-mail:

The authors report no conflict of interest.

Presented at Annual Meeting of the American Society of Anesthesiologists, October 22, 2016 , Chicago, IL.

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Accepted September 27, 2017

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