Reasons for Surgical Delay in HIP Fracture: What Can We Do From the Emergency Room?

Abstract

To identify the causes of surgical delay in patients with hip fracture, as recognized in the Emergency Department, and to assess their impact on mortality and hospital length of stay. A retrospective longitudinal study was conducted in a tertiary care Spanish hospital between January and June 2023, including 182 patients aged 65 years or older with hip fracture (76.9% women; mean age 836 ± 7.6 years). The reasons for surgical delay were analyzed, along with hospital length of stay and mortality during hospitalization and 10 months post-discharge. Dementia was present in 41.2% of cases, and the mean Barthel Index was 75.4 points. The median time to surgery was 4 days (IQR: 3-6). Surgery was performed within 72 hours in 41.8% of patients. The most frequent causes of surgical delay were admission during weekends or holidays (90.6%), lack of operating room availability (19.8%), severe renal failure (31.1%), severe infection (24.6%), neurological instability (23.6%), antiplatelet therapy (21.7%), and absence of accompanying family members (16%). Overall mortality was 18.8%. In multivariate analysis, patients operated within 72 hours showed no significant difference in mortality. However, those operated after 72 hours had a significantly longer hospital stay. Surgical delay in hip fractures is influenced by clinical, social, and institutional factors. Familiarity with clinical practice guidelines may help reduce avoidable delays and improve overall hospital length of stay.