Title : Impact of surgical timing on hospital length of stay following hemiarthroplasty and internal fixation for hip fractures: A six year retrospective cohort study
Abstract:
Background: Hip fractures are a major cause of morbidity and healthcare utilization among older adults. Although timely surgery is widely recommended, the effect of surgical timing on hospital length of stay remains debated, particularly in the Middle Eastern region. This study evaluated the association between surgical timing, hospital length of stay, and postoperative outcomes among elderly patients undergoing hip fracture surgery.
Methods: This retrospective cohort study included patients aged 60 years or older who underwent hemiarthroplasty or internal fixation for proximal femur fractures at King Abdulaziz Medical City in Jeddah, Saudi Arabia, between May 2019 and May 2025. Surgery was categorized as early when performed within 48 hours of admission and delayed when performed at or beyond 48 hours. The primary outcome was hospital length of stay. Secondary outcomes included intensive care unit admission, venous thromboembolism, respiratory infection, periprosthetic infection, and one-year mortality. Time to hospital discharge was evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards modeling. Relative risks with 95% confidence intervals were calculated for postoperative outcomes.
Results: A total of 179 patients were included; 100 patients (55.9%) underwent early surgery and 79 (44.1%) underwent delayed surgery. Median hospital length of stay was significantly shorter following early surgery than delayed surgery: 7 days (95% CI 6-7) versus 11.5 days (95% CI 9-14), respectively (log-rank p < 0.001). After adjustment for comorbidities, surgical factors, and prehospital delay, early surgery remained independently associated with earlier discharge (hazard ratio 2.17, 95% CI 1.55-3.04; p < 0.001). Intensive care unit admission was also less frequent following early surgery (6.0% versus 17.7%; relative risk 0.34, 95% CI 0.14-0.83; p = 0.013). No significant differences were identified in venous thromboembolism, respiratory infection, periprosthetic infection, or one-year mortality.
Conclusion: Hip fracture surgery performed within 48 hours of admission was associated with a significantly shorter hospital stay and fewer intensive care unit admissions. Timely surgery may improve perioperative efficiency and hospital resource utilization, although no clear differences were observed in one-year mortality or other postoperative complications.
