• Allen Tanner Ii, Stephanie Jarvis, Alessandro Orlando, Nnamdi Nwafo, Robert Madayag, Zachary Roberts, Chad Corrigan, Matthew Carrick, Pamela Bourg, Wade Smith, and David Bar-Or.
• Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA.
• J Clin Orthop Trauma. 2020 Feb 1; 11 (Suppl 1): S56-S61.

BackgroundThere are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost.MethodsThis was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost.ResultsThere were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001.ConclusionsThe results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs.Level Of EvidenceLevel III.© 2019 Delhi Orthopedic Association. All rights reserved.

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