Academic Journal
Hip fracture surgery within 24 hours: no association between time to surgery and mortality in a real-world cohort.
| Τίτλος: | Hip fracture surgery within 24 hours: no association between time to surgery and mortality in a real-world cohort. |
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| Συγγραφείς: | Pankratz C; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany. carlos.pankratz@uniklinik-ulm.de., Wolters M; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany., Cintean R; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany., Gebhard F; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany., Schuetze K; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany., Eickhoff A; Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery University Ulm Medical Centre, Albert-Einstein-Allee 23, 89081, Ulm, Germany. |
| Πηγή: | European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2026 Sep 15; Vol. 52 (1). Date of Electronic Publication: 2026 Sep 15. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 101313350 Publication Model: Electronic Cited Medium: Internet ISSN: 1863-9941 (Electronic) Linking ISSN: 18639933 NLM ISO Abbreviation: Eur J Trauma Emerg Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2011- : Heidelberg : Springer Heidelberg Original Publication: Munich : Urban & Vogel, 2007- |
| Ιατρικοί όροι (MeSH): | Time-to-Treatment*/statistics & numerical data , Hip Fractures*/surgery , Hip Fractures*/mortality, Germany/epidemiology ; Postoperative Complications/mortality ; Humans ; Female ; Retrospective Studies ; Male ; Aged, 80 and over ; Aged ; Risk Factors ; Proximal Femoral Fractures ; Time Factors ; Treatment Delay |
| Περίληψη: | Purpose: Early surgery is recommended for hip fractures, and in Germany, operative treatment within 24 h has been mandatory since 2021. While delays beyond 24-48 h are associated with worse outcomes, it remains unclear whether further acceleration within a 24-hour timeframe improves survival. This study evaluated mortality and perioperative risk factors within a strictly implemented early-treatment pathway. Methods: This retrospective single-centre cohort study included 1,051 consecutive patients with femoral neck and trochanteric fractures treated surgically within 24 h of admission (2016-2020). Time to surgery was grouped into < 6 h, 6-12 h, and > 12-24 h. The primary outcome was one-year mortality; secondary outcome was two-year mortality. Mortality data were obtained from the national citizen registry. Multivariable logistic and Cox proportional hazards regression analyses were performed for one-year mortality. Results: Mean time to surgery was 10.2 ± 6.2 h. One-year mortality was 29.5% and increased to 40.1% at two years. Mortality did not differ significantly between time-to-surgery groups (< 6 h: 30.9%, 6-12 h: 26.4%, > 12-24 h: 31.5%; p = 0.258). This finding was consistent across all adjusted analyses. In contrast, non-surgical complications were the strongest independent predictors of mortality, particularly pneumonia (OR 2.1), renal failure (OR 5.2), and cardiac events (OR 5.1). Surgical complications and implant choice were not associated with mortality. Conclusion: Within a 24-hour treatment pathway, further reduction of time to surgery was not associated with improved survival in this cohort. Mortality was strongly associated with perioperative medical complications. These findings support current early-surgery targets but suggest that optimisation of perioperative and orthogeriatric care may be at least as important for improving outcomes as further reductions in time to surgery. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethical approval: This study was approved by the Ethics Committee of the University of Ulm (approval number: 27/22). All procedures were conducted in accordance with the Declaration of Helsinki and its later amendments. Consent to participate: Due to the retrospective design and use of anonymised data, the requirement for informed consent was waived by the ethics committee. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Early surgical care; Hip fracture; Mortality; Outcome; Perioperative complications; Time to surgery |
| Entry Date(s): | Date Created: 20260915 Date Completed: 20260915 Latest Revision: 20260918 |
| Update Code: | 20260918 |
| PubMed Central ID: | PMC13577985 |
| DOI: | 10.1007/s00068-026-03331-0 |
| PMID: | 42742658 |
| Βάση Δεδομένων: | MEDLINE |
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