Patient and emergency department factors influencing surgery timing in patients with hip fracture

Abstract

Hip fractures are a significant health concern, increasingly common among the elderly. Surgical intervention is crucial and recommended within 48 h of presentation. Many patients with hip fractures present to the emergency department (ED), but the impact of ED-related factors remains unclear. This study investigated ED-related factors affecting surgical delay in hip fracture patients. This retrospective observational study evaluated patients aged ≥ 60 years with hip fractures who presented to a tertiary care university hospital ED between January 2017 and December 2022. Demographic and clinical variables, including ED-related factors such as length of stay and occupancy, were recorded. Outcomes were delayed surgery (i.e., performed after 48 h). Among 434 patients, 209 underwent early surgery and 225 delayed surgery. Univariate analyses revealed significant associations between time to surgery and comorbidities, presentation on the day before holidays, prolonged ED stay, surgery type, international normalized ratio, and albumin levels. In multivariable analysis, ischemic heart disease, presentation on the day before holidays, prolonged ED stay, surgery type, and albumin level ≤ 3.8 g/dL were significantly associated with delayed surgery. In conclusion, delayed surgery is associated with ischemic heart disease, pre-holiday presentation, prolonged ED stay, surgery type, and albumin ≤ 3.8 g/dL. © The Author(s) 2025.