• Hanna Leicht, Thomas Gaertner, Christian Günster, Andreas M Halder, Reinhard Hoffmann, Elke Jeschke, Jürgen Malzahn, Almut Tempka, and Josef Zacher.
• AOK Research Institute (WIdO), Berlin; Medical Service of German Statutory Health Insurance Providers (MDK) Hessen, Oberursel; Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld/Kremmen; BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt; AOK-Bundesverband, Berlin; Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin; HELIOS Health Kliniken GmbH, Berlin.
• Dtsch Arztebl Int. 2021 Jul 2; 118 (26): 454-461.

BackgroundIt has not been conclusively established whether, or to what extent, the time to surgery affects mortality and the risk of complications after the surgical treatment of proximal femoral fractures.MethodsData on 106 187 hospitalizations over the period 2015-2017 involving insurees of the German AOK health insurance company aged 20 and above were drawn from pseudonymized billing data and stratified in three subgroups: osteosynthesis for pertrochanteric fracture (PTF-OS: N = 52 358), osteosynthesis for femoral neck fracture (FNF-OS: N = 7970), and endoprosthesis for femoral neck fracture (FNF-EP: N = 45 859). Multivariate regression models were used to analyze the relation between preoperative in-hospital stay (time to surgery, TTS: 0 days [reference category], 1, 2, 3, 4-7 days) and mortality and general complications within 90 days, with risk adjustment for fracture site, operative method, age, sex, accompanying illnesses, and antithrombotic medication in the preceding year.ResultsMortality was significantly elevated only with PTF-OS, and only with a TTS of 2 days (odds ratio: 1.12 [95% confidence interval: (1.02; 1.23)]). General complications in relation to TTS were significantly elevated in the following situations: PTF-OS: 2 days: OR 1.24 [1.13; 1.37], 3 days: OR 1.33 [1.11; 1.60], 4-7 days: OR 1.47 [1.21; 1.78]; FNF-EP: 3 days: OR 1.21 [1.06; 1.37], 4-7 days: OR 1.42 [1.25; 1.62]; FNF-OS: 4-7 days: OR 1.86 [1.26; 2.73].ConclusionA prolonged time to surgery is associated with an elevated general complication risk depending on the site of the fracture and the type of surgical procedure used.

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