Surgery for hip fracture performed within 24 to 48 hours of injury or hospital admission was associated with better survival and recovery outcomes in older adults, according to a systematic review published in The Bone & Joint Journal.
The researchers conducted the review to evaluate the association between time to surgery—a commonly reported performance indicator in hip fracture care—and patient outcomes. The review followed PRISMA guidelines and was registered prospectively with PROSPERO, a public registry of systematic review protocols. A comprehensive search of 12 electronic databases, supplemented by reference list screening and grey literature searches, identified 24,791 records. After screening and full-text review, 139 studies published between 1980 and 2022 met inclusion criteria, representing 4,336,707 patients aged 50 years or older across 36 countries.
Most included studies were observational, comprising 130 cohort studies, 2 randomized clinical trials, 1 case-control study, and 6 pre–post intervention studies. Methodological quality, assessed using the Mixed Methods Appraisal Tool, was predominantly low to intermediate and informed interpretation but did not determine exclusion. Definitions of time to surgery varied widely between studies and health systems and were most often measured from hospital admission rather than from injury. Thresholds used to define ‘early’ surgery ranged from less than 3 hours to more than 7 days, precluding formal meta-analysis. To address this heterogeneity, researchers standardized reported timeframes into hourly categories and conducted a structured narrative synthesis.
“Early surgery for hip fracture in older people is associated with better clinical and patient-reported outcomes,” noted the researchers. Patient-reported outcomes were less frequently reported than clinical outcomes but generally favored earlier intervention. Surgery within 24 hours was associated with improved mobility, functional status, and health-related quality of life, with similar, though less consistent, benefits reported for surgery within 48 hours.
Clinical outcomes showed more consistent associations. Earlier surgery was linked to reductions in medical and surgical complications, shorter hospital length of stay, fewer readmissions, lower health care costs, and reduced mortality during the index admission as well as at 30 days and 12 months. Mortality benefits were more frequently reported for surgery within 48 hours, although several studies also demonstrated benefit within 24 hours.
The review had notable limitations. Inconsistent definitions of time to surgery limited comparability across studies and precluded quantitative synthesis, resulting in a narrative review. Reasons for surgical delay were frequently unreported or inadequately characterized, and because most included studies were observational, the observed associations may be subject to residual confounding rather than indicating causality.
The researchers reported receiving financial support from the National Institute for Health and Care Research Oxford Biomedical Research Centre.
Source: The Bone & Joint Journal