Waiting more than 24 hours for hip fracture surgery is associated with increased risk of adverse outcomes for sicker patients: a nationwide cohort study of 63,998 patients using the Swedish Hip Fracture Register

• Background and purpose: Waiting time to surgery is a modifiable risk factor in hip fracture surgery. However, there is no consensus regarding the acceptable duration of waiting time. We used the Swedish Hip Fracture Register RIKSHÖFT and 3 administrative registers to explore the association between time to surgery and adverse outcomes after discharge.Patients and methods: 63,998 patients ≥ 65 years, admitted to a hospital between January 1, 2012, and August 31, 2017 were included. Time to surgery was divided into < 12, 12–24, and > 24 hours. Diagnoses investigated were atrial fibrillation/flutter (AF), congestive heart failure (CHF), pneumonia, and “acute ischemia” (a combination of stroke/intracranial bleeding, myocardial infarction, and acute kidney injury). Crude and adjusted survival analyses were performed. Time spent in hospital following the initial hospitalization was described for the 3 groups.Results: Waiting > 24 hours was associated with an increased risk of AF (HR 1.4, 95%CI 1.2–1.6), CHF (HR 1.3, CI 1.1–1.4) and “acute ischemia” (HR 1.2, CI 1.01–1.3). However, stratifying for ASA grade revealed that these associations were present only in patients with ASA 3–4. There was no association between waiting time and pneumonia after the initial hospitalization (HR 1.1, CI 0.97–1.2), but one was found with pneumonia during hospital stay OR 1.2 (CI 1.1–1.4). Time in hospital after the initial hospitalization was similar over the waiting time groups.Conclusion: The associations between waiting > 24 hours for hip fracture surgery and AF, CHF, and acute ischemia suggest that shorter waiting time may reduce adverse outcomes for the sicker patients. 

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