Hip fracture: efficacy of early day surgery to prevent 30 days in-hospital mortality.

Background: Hip fracture represents an important cause of quality of life worsening and mortality in the elderly. Several studies evaluated the risk factors associated with post-operative mortality, but results are often discordant. The aim of our study is to assess whether there is an association between operative delay (2 or more days after hospital admission) and 30 day in-hospital mortality in patients with diagnosis of hip fracture discharged from an Italian teaching hospital. Methods: 1320 patients with diagnosis of hip fracture discharged from S.Orsola-Malpighi teaching hospital of Bologna were included. Gender, age and comorbidities, collected from hospital discharge records (SDO) and the American Society of Anesthesiologists score (ASA), International Normalised Ratio (INR) and Haemoglobin collected from clinical records were considered as potential risk factors. In the final logistic regression model only the factors selected by using a stepwise procedure (p entry =0.1 and p stay =0.05) were included. Results: The average mortality rate was 3.3% and the 56.5% (n=746) of patients had an operative delay less than 2 days. Age, male gender, diabetes and aritmia were the only factors statistically associated to mortality included in the final model. The adjusted RR of mortality for an operative delay of 2 days or more after hospital admission is 1.80 (95% CI=1.02-3.20) compared to an operative delay of less than 2 days. Conclusions: The operative delay is positively associated with an 80% increased risk of 30 day in-hospital mortality. These results suggest that organizational causes of the operative delay should be investigated in order to reduce waiting time for surgery.