Association of Timing of Surgery for Hip Fracture and Patient Outcomes

CONTEXT Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes. 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