• Devon J Ryan, Hiroyuki Yoshihara, Daisuke Yoneoka, Kenneth A Egol, and Joseph D Zuckerman.
• *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; †Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY; ‡Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY; and §Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tachikawa, Japan.
• J Orthop Trauma. 2015 Aug 1; 29 (8): 343-8.

ObjectivesTo empirically define a "delay" for hip fracture surgery based on clinical outcomes, and to identify patient demographics and hospital factors contributing to surgical delay.DesignRetrospective database analysis.SettingHospital discharge data.Patients/ParticipantsA total of 2,121,215 patients undergoing surgical repair of hip fracture in the National Inpatient Sample between 2000 and 2009.InterventionInternal fixation or partial/total hip replacement.Main Outcome MeasurementsLogistic regressions were performed to assess the effect of surgical timing on in-hospital complication and mortality rates, controlling for patient characteristics and hospital attributes. Subsequent regressions were performed to analyze which patient characteristics (age, gender, race, comorbidity burden, insurance status, and day of admission) and hospital factors (size, teaching status, and region) independently contributed to the likelihood of surgical delay.ResultsCompared to same-day surgery, each additional day of delay was associated with a significantly higher overall complication rate. However, next-day surgery was not associated with an increased risk of in-hospital mortality. Surgery 2 calendar days (odds ratio: 1.13) and 3+ days (odds ratio: 1.33) after admission was associated with higher mortality rates. Based on these findings, "delay" was defined as surgery performed 2 or more days after admission. Significant factors related to surgical delay included comorbidity score, race, insurance status, hospital region, and day of admission.ConclusionsSurgical delay in hip fracture care contributes to patient morbidity and mortality. A variety of patient and hospital characteristics seem to contribute to surgical delay and point to important health care disparities.Level Of EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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