Context Previous studies of surgical timing in patients with hip fracture have
yielded conflicting findings on mortality and have not focused on functional
Objective To examine the association of timing of surgical repair of hip fracture
with function and other outcomes.
Design Prospective cohort study including analyses matching cases of early
(≤24 hours) and late (>24 hours) surgery with propensity scores and excluding
patients who might not be candidates for early surgery.
Setting Four hospitals in the New York City metropolitan area.
Participants A total of 1206 patients aged 50 years or older admitted with hip fracture
over 29 months, ending December 1999.
Main Outcome Measures Function (using the Functional Independence Measure), survival, pain,
and length of stay (LOS).
Results Of the patients treated with surgery (n = 1178), 33.8% had surgery within
24 hours. Earlier surgery was not associated with improved mortality (hazard
ratio, 0.75; 95% confidence interval [CI], 0.52-1.08) or improved locomotion
(difference of −0.04 points; 95% CI, –0.49 to 0.39). Earlier surgery
was associated with fewer days of severe and very severe pain (difference
of −0.22 days; 95% CI, −0.41 to −0.03) and shorter LOS by
1.94 days (P<.001), but postoperative pain and
LOS after surgery did not differ. Analyses with propensity scores yielded
similar results. When the cohort included only patients who were medically
stable at admission and therefore eligible for early surgery, the results
were unchanged except that early surgery was associated with fewer major complications
(odds ratio, 0.26; 95% CI, 0.07-0.95).
Conclusions Early surgery was not associated with improved function or mortality,
but it was associated with reduced pain and LOS and probably major complications
among patients medically stable at admission. Additional research is needed
on whether functional outcomes may be improved. In the meantime, patients
with hip fracture who are medically stable should receive early surgery when