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Delay in Hip Fracture Surgery Prolongs Postoperative Hospital Length of Stay but Does Not Adversely Affect Outcomes at 30 Days

Mitchell, Sean M., MD*; Chung, Andrew S., DO*; Walker, Joseph B., MD*; Hustedt, Joshua W., MD*; Russell, George V., MD; Jones, Clifford B., MD*,‡

doi: 10.1097/BOT.0000000000001306
Original Article

Objectives: To evaluate the association between the timing of hip fracture surgery with postoperative length of stay and outcomes.

Design: Retrospective review using the American College of Surgeons National Surgical Quality Improvement Program database.

Setting: National inquiry database incorporating 140 academic and private medical centers.

Patients: Seventeen thousand four hundred fifty-nine patients who underwent surgery for a hip fracture between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database.

Intervention: Surgical management of hip fractures was performed at the discretion of participating surgeons.

Outcome Measure: Thirty-day outcomes including postoperative length of stay, readmission rates, reoperation rates, complications, and mortality rates.

Results: Of the 17,459 patients, 4107 (23.5%) were operated on within 24 hours, 8740 (50.1%) within 24–48 hours, and 4612 (26.4%) more than 48 hours after hospital admission. Increased time to surgery was associated with longer postoperative hospital length of stay. Prolonged time to surgery did not adversely affect postoperative outcomes.

Conclusions: Although a delay in the management of hip fractures is associated with an increase in postoperative hospital length of stay, 30-day postoperative outcomes are not adversely affected in patients undergoing hip fracture fixation.

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

*Department of Orthopaedic Surgery, The University of Arizona, Phoenix, AZ;

Department of Orthopaedic Surgery University of Mississippi Medical Center, Jackson, MS; and

The CORE Institute, Phoenix, AZ.

Reprints: Sean M. Mitchell, MD, Department of Orthopaedic Surgery, The University of Arizona, College of Medicine Phoenix, 1320 N 10th St, Suite A Phoenix, AZ 85006 (e-mail:

C. B. Jones receives IP royalties from Lippincott. G. V. Russell is a paid speaker AONA, receives research funding from METRC & Synthes, and holds stock in SMV & Zimmer. The remaining authors report no conflict of interest.

Presented as a poster at the Annual Meeting of the Orthopaedic Trauma Association, October 11–14, 2018, Vancouver, Canada.

Presented as an e-poster at the International Geriatric Fracture Society Annual Meeting, October 11, 2017, Vancouver, Canada.

Accepted July 12, 2018

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