• Nathalie Declarador, Rani Ramason, Laura Tay, Chan Wai Lim William WLW 3 Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore., and Kwek Ernest Beng Kee EBK 4 Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore..
• 1 Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
• J Orthop Surg (Hong Kong). 2018 May 1; 26 (2): 2309499018783909.

PurposeEarly surgery for older adults with hip fracture has been shown to improve outcomes. We aim to study the factors contributing to delay in surgery (defined as surgery performed more than 48 h after admission) and its associated outcomes in a tertiary hospital in Singapore with an integrated hip fracture program.MethodsThis is a prospective cohort study of hip fracture patients aged more than 60 years over 1 year. We collected data on demographics, premorbid mobility and functional status, time to surgery, postoperative complications, and inhospital mortality. Mortality data and functional performance were reviewed at 1 year.ResultsHigh American Society of Anaesthesiologists score independently predicted delay in surgery (odd ratio (OR) = 9.52, 95% confidence interval (CI): 1.69-53.68). Delayed surgery was significantly associated with longer length of stay (median 12.8 days with interquartile range (IQR) 9.7-17.6 days vs. 8.35 days with IQR 5.9-10.9 days, p < 0.01). Surgery within 48 h significantly reduced functional decline (Modified Barthel Index change -3.89 ± 17.23 vs. -9.29 ± 20.30, p = 0.01) and 1-year mortality (3.5% vs. 9.3%, p = 0.03). Surgical delay was an independent risk factor for early postoperative complications (OR = 3.21, 95% CI: 1.21-8.49), and patients were significantly less likely to return to premorbid mobility at 1 year (OR = 0.62, 95% CI: 0.39-0.97).ConclusionsDelayed hip fracture surgery in older adults is associated with worse short- and long-term outcomes, including early postoperative complications and poorer functional recovery.

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