The use of direct oral anticoagulants (DOACs) may delay surgery in older hip fracture patients.

To assess whether preoperative DOAC activity measurement enables surgery within 48 h in hip fracture patients at a similar prevalence compared to patients receiving other antithrombotics or no antithrombotics.

A retrospective observational cohort study of hip fracture patients older than 65 years admitted to three Orthogeriatrics units in Italy from 2015 to 2022 was conducted. At admission, demographical and comorbid conditions were recorded, and antithrombotics were stopped. Patients on vitamin K antagonists (VKAs) underwent international normalized ratio (INR) assessments and received vitamin K to achieve an INR below 1.5. Patients receiving DOACs who were enrolled before 2018 underwent daily drug testing, and surgery was performed only after DOAC levels were near or below trough levels. Hours from hospital admission to surgery, perioperative total blood loss, major bleeding and mortality at 90 days were recorded.

Amongst the 747 patients (median age 85 years; M/F: 192/555), the prevalence of surgery within 48 h was significantly lower amongst patients receiving DOACs (47%) than amongst patients receiving antiplatelet agents (77%) and patients receiving no antithrombotic agents (73%). Preoperative DOAC measurements significantly delayed the time to surgery (median 51 vs. 42 h: P < 0.05). The major bleeding and mortality rates at 90 days did not differ based on the type of antithrombotics used. The degree of perioperative blood loss was greater in patients receiving DOACs, regardless of drug measurement, than in patients taking other antithrombotics.

DOAC measurement may delay hip fracture surgery, as even low presurgical levels of DOACs are associated with greater perioperative blood loss.

With the characteristics of population change, geriatric hip fracture is increasing, accompanied by high morbidity and mortality rates. However, limited research has thoroughly investigated the postsurgery functional outcomes of hip fractures in the elderly population.

This study included 993 patients who underwent hip fracture surgery, drawn from a prospective cohort in China. Demographic and clinical data were collected for all participants. The cohort was randomly divided into training and validation sets (8:2). Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were employed to identify predictive factors for hip function at 12 months postoperatively. A nomogram was developed using R software and evaluated using concordance index (C-indexes), area under the curve (AUC), decision curve analysis (DCA), and calibration curves.

Patients were divided into training (n = 794) and validation set (n = 199). Eight independent predictive variables for the poor functional outcome (Harris Hip Score < 80) after hip fracture include age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), hypertension history (OR, 2.53; 95% CI, 1.50-4.23), fracture type (OR, 0.28; 95% CI, 0.17-0.48), blood transfusion (OR, 2.30; 95% CI, 1.35-3.94), baseline PARKER score (OR, 0.85; 95% CI, 0.75-0.97), adverse events occurred within 12 months postoperatively (OR, 5.49; 95% CI, 2.30-13.08), transfer to the rehabilitation institution (OR, 3.22; 95% CI, 1.51-6.88), and time from surgery to weight-bearing (OR, 1.02; 95% CI, 1.01-1.03). The nomogram demonstrated excellent predictive ability in the training set (AUC = 0.853, [95% CI: 0.816-0.890]). Furthermore, according to the calibration curve, the model's prediction and actual observation were in good consistency, and the DCA curve demonstrated good clinical usefulness.

This study developed a personalized, predictive nomogram with eight risk factors for predicting 1-year functional outcomes in geriatric patients with hip fractures. Our model facilitates the early identification of high-risk patients and enables surgeons to implement timely preventive interventions.

The aim of this study was to determine if a delay to surgery of more than 48 h was associated with poorer functional outcomes and increased 1-year mortality rates for elderly hip fractures.

A retrospective review of surgically treated elderly (≥ 60 years old) hip fracture patients in a single institution was conducted. Patients were divided into 2 groups depending on hours from admission to surgery: Group 1 ( ≤ 48 h) and Group 2 (> 48 h); these groups were 1:1 matched for the initial Modified Barthel's Index (MBI) and Charlson Comorbidity Index (CCI).

2562 patients were eligible for the study. The cut-point value in a receiver operating curve analysis for 12-month MBI against time to surgery was not robust enough to determine an optimal time for surgery. Group 1 (n = 888) had significantly better MBI scores at 6-months [mean 78.7 (± 19.9) vs. mean 75.5 (± 20.6)] and 1-year [mean 80.4 (± 20.1) vs. mean 76.9 (± 22.3)] (p < 0.001). This difference in MBI scores between the groups did not meet the minimal clinically important difference of 10  points. There was no significant difference in 1-year mortality (3.7% vs. 4.4%) (p = 0.427). Delayed surgery past 48 h significantly increased the risk of post-operative complications. (Urinary tract infection, acute retention of urine and pneumonia) (p < 0.001).

Delayed surgery for elderly hip fractures after 48 h increases the risk of acute post-operative complications. There is no increase in 1-year mortality and no clinically important deterioration of MBI if operated on after 48 h.

III.

Time to surgery (TTS) increases mortality risk in old patients with proximal femur fractures (PFFs). Orthogeriatric care pathways reduce mortality and length of stay, but the interaction between TTS and geriatric intervention remains unclear.

To identify organisational variables-including geriatric intervention-that are predictive of 90-day mortality and explore their interactions with TTS.

This retrospective study included 7756 PFFs aged over 60 who underwent surgery between 2005 and 2017. Organisational factors influencing 90-day mortality (main outcome) were identified in an administrative database using log-rank tests. Variables such as a mobile geriatric team (MGT) intervening in the emergency department were screened. Selected variables were included in a Cox model alongside TTS and the AtoG score, a validated multidimensional prognostic tool (from 0 no comorbidity to ≥5). Statistical interactions between TTS and organisational variables were calculated.

MGT was one of the rare organisational variables with a protective effect: hazard ratio (HR) = 0.81, CI 95% [0.68-0.98], P = 0.03. MGT's strongest effect was for TTS up to 1 day (HR = 0.70, CI95% [0.53-0.92], P = 0.01) and then decreased beyond 2 days (HR = 0.97, CI95% [0.73-1.3], P = 0.08). In patients with an AtoG score ≤ 2, MGT was the strongest parameter: HR = 0.76, CI95% [0.60-0.93], P = 0.03, while the HR for TTS was 1.01 CI 95% [0.99; 1.02], P = 0.15. In patients with an AtoG>2, there was a synergic interaction between MGT and reduced TTS (P = 0.05).

Geriatric intervention modulated the effect of TTS on 90-day mortality up to a TTS of 2 days. MGT had a positive impact on both vulnerable and earthier patients.

The management of elderly patients undergoing hip fracture surgery often involves those on anticoagulation therapy, posing challenges in surgical timing and outcomes. This study evaluates the prevalence of anticoagulation therapy, its impact on surgical timing, and postoperative outcomes within an Orthogeriatric Clinical Care Center (OCCC).

A retrospective review of 638 patients aged 65 and above treated for hip fractures from May 2014 to December 2023 at the OCCC was conducted. Data on anticoagulant use, surgical timing, and outcomes were analyzed using multivariate logistic regression to adjust for confounders, such as age, preoperative hemoglobin levels, and comorbidities.

Anticoagulation therapy was present in 14.7% of patients, primarily with direct oral anticoagulants (12.2%). There was no significant delay in surgical timing for anticoagulated patients (mean time to surgery: 31.5 ± 23.3 h) compared to non-anticoagulated patients (28.7 ± 15.7 h, p = 0.272). Additionally, no significant differences were observed in transfusion requirements, ICU admissions, or mortality rates at 30 days and 1 year postoperatively between the two groups.

Timely surgery for hip fractures is achievable in elderly patients on anticoagulation therapy and does not negatively impact critical postoperative outcomes when managed within a structured OCCC protocol. These findings support the use of standardized perioperative anticoagulation management protocols to ensure timely surgery and optimize patient recovery. Further research is recommended to validate these findings in broader clinical settings.

An early surgery for older adult patients with hip fractures is recommended to avoid perioperative complications in existing clinical guidelines. Few studies have analyzed only transtrochanteric fractures. The purpose of this study was to assess whether surgery within two days of admission reduces the incidence of pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization in patients with older adult transtrochanteric femur fractures. In this retrospective study, we used the Japanese National Administrative DPC (Diagnosis Procedure Combination) database that covers April 2016 to March 2022. Transtrochanteric femur fracture was included in patients aged 65 years or older who underwent surgery. The perioperative complications with pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization were assessed after propensity score matching, focusing on surgeries conducted within two days of admission. After one-to-one propensity score matching for age, sex, and comorbidity, we identified 79,649 pairs of patients who underwent surgery either within two days or after the third day of admission. Surgery delayed beyond two days was independently associated with increased pneumonia, pulmonary embolism, pressure ulcers, and mortality during hospitalization with risk ratios of 1.335 (95% CI: 1.256-1.418, p < 0.0001), 1.287 (95% CI: 1.225-1.351, p < 0.0001), 1.229 (95% CI: 1.094-1.380, p < 0.0001), and 1.063 (95% CI: 0.978-1.155, p = 0.0035), respectively. Surgery within two days of admission for transtrochanteric femur fracture effectively prevents perioperative complications and reduces mortality during hospitalization.

Hip fractures in the elderly present a significant public health challenge globally, especially among patients with hypertension, who are at an increased risk of developing preoperative deep vein thrombosis (DVT). DVT not only heightens surgical risks but also severely impacts the rehabilitation and quality of life of patients. Early risk assessment and management in this population are therefore critically important. This study aimed to develop and validate a machine learning-based predictive model to enhance the accuracy of predicting preoperative DVT in elderly patients with hypertension undergoing hip fracture surgery, thereby optimizing preoperative assessment and management. A retrospective study design was employed, selecting patients with hypertension and hip fractures treated at the First Hospital of Qinhuangdao from January 2018 to December 2022. Key predictive factors were identified using LASSO regression, and logistic regression was utilized to construct both a nomogram and an online interactive nomogram. Various machine learning algorithms were also employed to build predictive models. The contribution of variables in the models was explained using SHAP values, and model performance was evaluated through ROC curves, AUC values, and other statistical methods. The study included 637 patients, with LASSO regression selecting key variables that were further used to develop a logistic regression-based nomogram and its online version, providing intuitive tools for assessing DVT incidence. Among the multiple machine learning predictive models, the LightGBM model exhibited the best performance, achieving an AUC of 0.910. The model's effectiveness and reliability were confirmed through decision curves, calibration plots, and precision-recall curves. SHAP value analysis highlighted the significance of factors such as age, time from injury to hospital admission, atrial fibrillation, C-reactive protein, hypoalbuminemia, and D-dimer levels in the predictions, enhancing the model's transparency and interpretability. This study successfully developed a logistic regression-based nomogram and multiple machine learning algorithms to predict the risk of preoperative DVT in elderly hypertensive patients with hip fractures. The nomogram provides clinicians with a practical tool for rapid risk assessment, thus optimizing patient management and prognosis. The LightGBM model, recommended for its high predictive accuracy, along with SHAP value analysis, enhanced the transparency and clinical applicability of the models. These findings not only deepen our understanding of DVT incidence factors but also demonstrate the potential of machine learning technologies in enhancing medical decision-making and advancing precision medicine.

Background and Objectives: Proximal femur fractures represent a significant health issue in the elderly, associated with high morbidity and mortality rates. This retrospective cohort study investigated factors influencing mortality (age, gender, infection, mobilization status, hospital stay length, surgical delay) in patients undergoing hemiarthroplasty for proximal femur fractures in a tertiary university hospital in Turkey. Materials and Methods: A retrospective analysis was conducted on 481 patients who underwent hemiarthroplasty at 19 Mayıs University hospital in Turkey between 2012 and 2022, with final follow-up data collected in 2022. Data collected included demographic information, the type of surgical approach, the duration of surgery, comorbidities, postoperative complications, and mobilization status at 1 and 6 months post-surgery. Statistical analyses were performed using the Mann-Whitney U test for age and surgery delay; the Kruskal-Wallis test for comparisons of mortality subgroups; the Chi-square test for categorical variables such as gender, fracture type, anesthesia type, and postoperative complications; and the Z test for post hoc analysis of categorical data. Results: The overall mortality rate at final follow-up was 56.1% over the entire study period (2012-2022), with a 6-month mortality rate of 21.8% and a 1-year mortality rate of 33.2%. Age and male gender were significant predictors of mortality. Infection rates were significantly associated with higher mortality within the first year. The study found no significant relationship between surgical approach, duration of surgery, or anesthesia type and mortality. However, increased length of hospital stay and delayed surgery correlated with higher mortality rates. Mobilization status significantly impacted survival, with immobilized patients demonstrating the highest mortality rates. Conclusions: Mortality following hemiarthroplasty for proximal femur fractures is influenced by various factors, including age, comorbidities, infection, and mobilization status. Implementing strategies for early surgery and mobilization while maintaining strict aseptic techniques could potentially reduce mortality rates in this high-risk population.

Transferring hip fracture patients may increase morbidity and cost. The purpose of this study was to examine time to surgery, outcomes, and cost in patients undergoing operative management of displaced femoral neck fractures (DFNFs), comparing those admitted through the emergency department (ED) and those transferred from outside hospitals.

A retrospective review of surgically managed DFNF patients (age ≥ 65 years) at a single institution between May 29, 2020, and December 29, 2022, was performed. Patients were categorized into two groups: "ED arrivals" and "transfers." Demographics, time from presentation to surgery, hospital length of stay, discharge disposition, 1-year readmission, reoperation, and mortality, and total cost of care were collected and compared. We identified 459 patients (ED = 422, 92.0%, Transfer = 37, 8.0%). There was no difference in age, sex, body mass index, or American Society of Anesthesiologists status.

Median time from ED to operating room was higher in the transfer group (41.6 versus 23.2 hours, P < 0.0001). Transfer and ED patients had similar length of stay (5.9 versus 6.0 days, P = 0.29) and similar rates of discharge to skilled nursing facility (66.1 versus 62.2%, P = 0.39). There was a higher rate of 1-year mortality (27.0 versus 13.5% for ED, P = 0.03) in transfer patients but no difference in 1-year readmission or reoperation. Adjusting for demographics, transfer patients had 2.6 higher odds of 1-year mortality than ED patients (odds ratio = 2.59 (1.13 to 5.94) P = 0.03). The cost of care was higher for transfer patients ($23,521 versus $13,980, P < 0.0001).

Transferring DFNF patients was associated with delayed time to surgery, increased 1-year mortality, and higher costs. Transferring patients is a logistical reality for many conditions; however, efforts should be made to provide efficient, safe, and cost-effective care.

To assess the added value of artificial intelligence (AI) for radiologists and emergency physicians in the radiographic detection of pelvic fractures.

In this retrospective study, one junior radiologist reviewed 940 X-rays of patients admitted to emergency for a fall with suspicion of pelvic fracture between March 2020 and June 2021. The radiologist analyzed the X-rays alone and then using an AI system (BoneView). In a random sample of 100 exams, the same procedure was repeated alongside five other readers (three radiologists and two emergency physicians with 3-30 years of experience). The reference diagnosis was based on the patient's full set of medical imaging exams and medical records in the months following emergency admission.

A total of 633 confirmed pelvic fractures (64.8% from hip and 35.2% from pelvic ring) in 940 patients and 68 pelvic fractures (60% from hip and 40% from pelvic ring) in the 100-patient sample were included. In the whole dataset, the junior radiologist achieved a significant sensitivity improvement with AI assistance (Se-PELVIC = 77.25% to 83.73%; p < 0.001, Se-HIP 93.24 to 96.49%; p < 0.001 and Se-PELVIC RING 54.60% to 64.50%; p < 0.001). However, there was a significant decrease in specificity with AI assistance (Spe-PELVIC = 95.24% to 93.25%; p = 0.005 and Spe-HIP = 98.30% to 96.90%; p = 0.005). In the 100-patient sample, the two emergency physicians obtained an improvement in fracture detection sensitivity across the pelvic area + 14.70% (p = 0.0011) and + 10.29% (p < 0.007) respectively without a significant decrease in specificity. For hip fractures, E1's sensitivity increased from 59.46% to 70.27% (p = 0.04), and E2's sensitivity increased from 78.38% to 86.49% (p = 0.08). For pelvic ring fractures, E1's sensitivity increased from 12.90% to 32.26% (p = 0.012), and E2's sensitivity increased from 19.35% to 32.26% (p = 0.043).

AI improved the diagnostic performance for emergency physicians and radiologists with limited experience in pelvic fracture screening.

Total hip arthroplasty (THA) allows for the replacement of impaired parts of the hip joint with artificial ones. This study aimed to compare the differences in preoperative patient profiles, postoperative complications, and clinical outcomes of two patient groups: those who underwent THA for fractures and those who underwent THA electively for diseases such as osteoarthritis (OA) and avascular necrosis (AVN).

We retrospectively analyzed the data of patients who underwent THA between March 2012 and December 2021. Of 232 patients, 173 patients who met the exclusion and inclusion criteria were included. Patients were divided into two groups (Group 1: 113 patients diagnosed with OA or AVN; Group 2: 60 patients diagnosed with hip fracture). Pre- and postoperative Visual Analogue Scale (VAS), Koval scores, and postoperative modified Harris Hip Score (mHHS) were used to assess clinical outcomes. Demographic data and postoperative complications of the two groups were compared. After surgery, a rehabilitation protocol was initiated.

Patients in Group 2 (fracture) had more preoperative comorbidities than those in Group 1 (elective). Follow-up months are 26.22 ± 19.78 (Group 1), and 27.42 ± 17.02 (Group 2) respectively (P > 0.05). There were no statistical differences in the prevalence of postoperative complications between two groups (P > 0.05). Compared with Group 1(elective), Group 2(fracture) showed lower VAS (P < 0.01) at last follow-up, and no difference in Koval score (P = 0.77) and mHHS (P = 0.96) at last follow-up.

Considering the characteristics of the two groups and their perioperative multidisciplinary care, THA for hip fractures can provide good clinical results compared to those with elective THA.

This study aimed to evaluate the outcomes and complications associated with hip fractures in patients with rheumatoid arthritis (RA) relative to those without RA.

Using the Japanese National Administrative Diagnosis Procedure Combination database, we examined cases of hip fractures from April 2016 to March 2023. After one to three propensity score matching for age, sex, and complications, we examined the association between RA, complications, and mortality during hospitalization in elderly patients with hip fractures.

The findings revealed that elderly Japanese RA patients with hip fractures had significantly higher complications of pneumonia than elderly hip fracture patients without RA, with a ratio of 1.232 [95% confidence interval (CI): 1.065-1.426, P = .0056], and pulmonary embolism, with a ratio of 1.155 (95% CI: 1.036-1.287, P = .009) in multivariate logistic regression analyses. Although not significantly elevated, it also found a trend towards higher mortality during hospitalization, with a ratio of 1.179 (95% CI: 0.973-1.429, P = .096).

This study revealed a significant association between RA and increased complications, including pneumonia and pulmonary embolism in hip fractures in the elderly. Implementing preventive strategies is essential to minimizing complications in the treatment of hip fractures in patients with RA.

Background: Venous thromboembolism frequently complicates orthopedic surgery. The aim of the study was to evaluate the overall incidence, site, and risk factors for venous thromboembolism in patients undergoing hip fracture surgery in DVT prophylaxis according to guidelines recommendations. Methods: Standard ultrasonography (CUS) was performed in the 5-6th postoperative day in all patients who underwent hip fracture surgery between 1 January and 31 December 2019. Pharmacological prophylaxis was started within 12 h from admission. In the first half of the year, dalteparin (5000 IU/day) was available while nadroparin (38 IU/kg until 3rd postoperative day and thereafter 57 IU/kg) was available in the second part of the year. Results: A total of 505 patients, 144 males and 361 females, with a mean age of 84 years, entered in the study. Post-operative DVT was found at screening ultrasonography in 121 patients (24%). Most involved distal veins (91) while proximal DVT occurred in 30. Two patients had not fatal pulmonary embolism (0.3%). Time to surgery (p = 0.0009) and ≥2 comorbidities (p = 0.0198) were independent predictive factors of DVT. Moreover, dalteparin prophylaxis was associated with a 1.7-times higher risk of developing a DVT compared to nadroparin. Conclusions: DVT occurs in 24% of patients after hip fracture surgery despite thromboprophylaxis. Time to surgery and ≥2 comorbidities were independent risk factors. The protective effects of nadroparin should be confirmed by a randomized trial. All patients with DVT were discharged with indication to anticoagulation for at least three months.

Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it.

Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality.

One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18 h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002).

Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation.

IV (Retrospective cohort study).

Hip fractures are a significant concern for the elderly population due to their impact on health and well-being. Surgical interventions, including hip arthroplasty and osteosynthesis, play a crucial role in the management of these fractures. In 2015, a hospital-based protocol was introduced to expedite surgical interventions within 48 hours of admission for elderly patients with hip fractures, aiming to enhance preoperative care and minimize delays.

This retrospective observational study aimed to evaluate the effects of protocol implementation on elderly patients (aged >60 years) undergoing osteosynthesis for hip fractures. Primary objectives included assessing postoperative complications, 30-day and one-year mortality rates, functional recovery, and length of hospital stay. The secondary objective was to explore the impact of early surgical intervention (within 48 hours of admission) on these outcomes.

Electronic medical records of hip fracture patients treated at Braga Public Hospital from 2013 to 2016 were retrospectively reviewed.

We included a total of 744 patients, with 391 in the pre-protocol group and 353 in the post-protocol group. Protocol implementation led to a significant increase in surgeries performed within 48 hours of admission (36% versus 53%). While post-protocol patients were older and had higher comorbidity scores, they experienced more postoperative complications. However, their hospital stay was shorter, with no significant changes in mortality rates or time to assisted ambulation.

This study highlights the benefits of protocol implementation in expediting surgical interventions for elderly hip fracture patients. Despite increased complications, the protocol reduced hospital stay without affecting mortality rates. Early surgical intervention was associated with faster postoperative mobilization.

The effectiveness of early surgery in preventing complications in elderly Japanese hip fracture patients and the impact of weekend hospitalization need further investigation. The purpose of this study was to determine whether weekend hospitalization affects the incidence of various sequelae and death during hospitalization in elderly hip fracture patients using a comprehensive Japanese hip fracture case database.

We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. During this period, approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for the study. The study focused on weekend hospitalizations and investigated the associations with postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, dementia, and in-hospital mortality after propensity score matching. Owing to the large population size of the study, significance levels were strictly enforced, and a P-value < 0.001 was considered statistically significant.

After performing propensity score matching based on age, sex, and comorbidities, 111 035 patient pairs were identified, comparing those admitted on weekends versus weekdays. The analysis showed no heightened risk of sequelae for those admitted during the weekend compared with weekdays. Additionally, there was a slight trend toward higher mortality risk during weekend hospital stays; however, the increase was insignificant, with a hazard ratio of 1.071 (95% confidence interval: 1.005-1.140, P = 0.03).

The results of this study indicate that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in-hospital mortality and that the importance of early surgery for elderly patients with hip fractures may be recognized and promoted in Japan. Geriatr Gerontol Int 2025; 25: 75-81.

A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration.

We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery.

Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10 mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery.

Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Hip fractures are common and are a major cause of significant morbidity and mortality in the elderly population, particularly when treatment is delayed. The British Orthopaedic Association's (BOA) guidelines state that surgical treatment should be performed within 36 hours of admission. This study aimed to investigate the effects of delays in surgery on clinical outcomes and to evaluate mortality rates over a three-year follow-up period following proximal femoral fractures.

This was a single-center, retrospective observational study of all patients aged ≥60 years admitted with low-energy hip fractures between June 1, 2020, and November 30, 2020. A total of 205 patients were included and followed up for three years. Data were collected from electronic medical records and operating theater notes. Statistical analysis was performed to analyze the effects of delay in surgery on clinical outcomes.

A 45.9% all-cause mortality rate was observed at three years post-hip fracture in this study. A delay of more than 36 hours to surgery was associated with a statistically significant increase in both length of hospital stay and mortality at one and three years, while no difference was observed in hip-related complications.

The three-year mortality rate compares well with those found in the literature. A delay in the surgical management of hip fractures is associated with overall worse clinical outcomes, with a higher mortality rate at three years.

Hip fractures are still associated with high morbidity and mortality. Despite international guidelines advocating for urgent surgical treatment, delays often occur, particularly for patients on long-term antithrombotic therapy. We hypothesised that urgent surgical care for the anticoagulated hip fracture patient is not associated with severe bleeding complications.

For the period from 2015 to 2021, we retrospectively reviewed clinical records of 1142 patients with proximal femur fractures treated within 24 h of admission to our trauma centre (mean age 80.4 ± 12.4 years; 761 females, 381 males). The cohort comprised 409 femoral neck and 733 trochanteric fractures, managed with either arthroplasty (n = 297), hip-preserving techniques (n = 147), or intramedullary nailing (n = 698). Of these, 583 patients (51.1 %) were on long-term antithrombotic therapy. The primary endpoints included transfusion rate and the difference in haemoglobin (Hb) levels from pre- to postoperative. Secondary endpoints were in-patient mortality and occurrence of postoperative haematomas requiring surgical revision. A regression analysis was performed.

The mean time to surgery was 10.3 h, with delays observed in patients on direct oral anticoagulants (DOACs). Overall, 25.9 % (n = 296) of the patients required blood transfusions. The transfusion rate was dependent on duration of the surgery, preoperative Hb level, and anticoagulation with DOACs. Similarly, the Hb difference was found to be dependent on the duration of surgery, preoperative Hb level, and anticoagulation with DOACs. In-patient mortality was 5.3 % (n = 60). Regression analysis indicated that mortality was dependent on a high ASA classification of 4 and the time to surgery, but not on the type of antithrombotic therapy. 3.1 % of the patients needed surgical revision due to postoperative haematoma with prolonged duration of surgery and antithrombotic therapy (PAI [OR = 3.7, 95 % CI: 1.1-12.7], DOACs [OR = 3.4, 95 % CI: 1.3-8.8], and VKA [OR = 5.5, 95 % CI: 1.8-17.1], p < 0.05) as independent risk factors.

As postoperative haematoma and the need for transfusion are manageable situations, we conclude that immediate surgical treatment of hip fracture patients on long-term antithrombotic therapy within 24 h is feasible and patients may benefit.

The widespread acceptance of early surgery as a treatment for acute intertrochanteric fracture (ITF) has been accompanied by ongoing controversy due to conflicting conclusions presented in previous studies. This study aims to compare the occurrence of perioperative complications and mortality, as well as functional outcomes in older patients with ITF who underwent either early or delayed surgery.

A retrospective multicenter cohort study involving 7414 patients with ITF between Jan. 2017 and Dec. 2021 was conducted. After predefined participants selection inclusion and exclusion criteria, 2323 surgically treated ITF patients were included and analyzed utilizing propensity score matching (PSM) method. Their demographics, injury-related data, surgery-related data, and perioperative adverse outcomes during hospitalization were collected and compared between the early or delayed surgery groups by PSM with a 1:4 ratio. All participants received a minimum of two-year follow-up and perioperative outcomes, functional outcomes, and survival analyses were conducted and compared.

After adjustment for potential confounders, there were no significant difference in surgery duration, intraoperative blood loss, transfusion rate, mortality rates, functional outcomes, and perioperative complications rates including severe complications, cardiac complications, pulmonary complications, and neurological complications regardless of whether the patient was treated with early or delayed surgery (all P > 0.05). Although length of hospital stay (mean, 11.5 versus 14.4 days, P < 0.001), total hospital costs (mean, 39305 versus 42048 yuan, P < 0.001), and minor complications rates including hematological complications (31.7% versus 41.2%, P = 0.007) and nutritional/metabolic complications (59.3% versus 66.4%, P = 0.039) were lower in the early surgery group, our result indicated patients with early surgery were more inclined to receive more blood transfusion (mean, 2.8 versus 2.2 units, P = 0.004).

Our findings suggest that a 48-hour delay in surgical intervention for older patients with an ITF does not result in a higher mortality rate, worse functional outcomes, and increased incidence of major perioperative complications when compared to early surgery. While expedited surgery is undoubtedly necessary for suitable patients, a reasonable preoperative delay of 48 h may be justified and safe for those with severe conditions, rather than strictly adhering to the current guidelines.

This study sought to answer the following questions: (1) Are there differences in knowledge on time to treatment (TTT) between stroke, myocardial infarction (MI), and hip fractures in the general population? (2) Are there differences in condition-specific knowledge across these conditions? (3) Are there underlying demographic factors that may contribute to differences in hip fracture-specific knowledge?

This was a cross-sectional cohort analysis. Participants were acquired using an online survey distribution platform, Amazon Mechanical Turk (MTurk). Individuals older than 18 years with English fluency and literacy were included. A total of 913 participants who completed a survey with questions on TTT knowledge, condition-specific knowledge, history of hip fracture, and demographics were recruited.

On comparing TTT knowledge, the MI mean score was 36.92% higher than that of hip fractures (P<.0001). On comparing condition-specific knowledge, the MI-specific mean score was 8.24% higher than that of hip fractures (P<.0001). Hip fracture knowledge was associated with demographic factors. Asian and Black participants and participants with Medicaid or Medicare as their primary insurance type were associated with significantly lower hip fracture knowledge.

Hip fracture knowledge was significantly lower than MI knowledge in the study population. Just as professional societies have invested resources in public education campaigns on the importance of TTT for stroke and MI, public education campaigns on the importance of TTT for hip fractures may support earlier TTT for populations vulnerable to delays (Asian and Black). [Orthopedics. 20XX;4X(X):XXX-XXX.].

The efficacy of early surgery in preventing complications among Japanese elderly patients with hip fractures requires further investigation. This study aims to use a comprehensive Japanese hip fracture case database to determine whether surgery within the day of admission and the following day reduces the incidence of complications and mortality during hospitalization in elderly hip fracture patients.

We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day.

After one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307-1.426), 1.328 (95% CI 1.169-1.508), 1.338 (95% CI 1.289-1.388), and 1.167 (95% CI 1.103-1.234), respectively.

A comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.

The aim of this comparative study was to examine the possible benefits of a dedicated Orthopaedic Trauma Room (DOTR) and in the care of patients with proximal femur fractures. A retrospective study of all orthopaedic cases with a hip fracture from 2020 to 2022 at CHC Montlegia has been undertaken, the group is compared to patients with the same impairment from 2018-2020 admitted to Saint Joseph/Esperance CHC hospitals (before the merge and the existence of a DOTR). The delay between the arrival at the emergency department and transfer to the operating room, as well as the mortality are evaluated. The length of hospital stay, the operating time, the ASA score, and the Charlson Index were also examined. A total of 734 cases were analysed, with 384 patients pre-DOTR and 350 patients post-DOTR. The 2 groups were compara- ble in gender, age, fracture type, Asa-score and Charlson Index. The time to the operating room (OR) has been reduced by 14h36 (37h35 vs 23h09, p< 0,001). There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. Novel oral anticoagulants (NOAC) intake showed no significant effect on the mortality postoperatively. The Length of hospital stay in your study was decreased by 1, 54 days (p< 0,001). A dedicated orthopaedic trauma room reduced the time to OR and the length of hospital stay. There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. With a DOTR, the care of trauma patients can be optimized and should become a standard of care.

The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures.

This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples t test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors.

175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48 hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90 days.

Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates.

Globally, fall-related injuries are a substantial problem, and 80% of fatal falls occur in low-income and middle-income countries. We aimed to measure time from injury to hip-fracture surgery in people aged 50 years or older living in low-income and middle-income regions, as well as to measure the proportion of patients with surgical stabilisation of their hip fracture within 72 h of admission to hospital and to identify risk factors associated with surgical delay.

For this secondary analysis, we analysed data collected from Africa, Latin America, China, India, and Asia (excluding China and India) for the International Orthopaedic Multicentre Study in Fracture Care (INORMUS) between March 29, 2014, and June 15, 2022. Patients from INORMUS were included in this analysis if they were aged 50 years or older and had an isolated, primary hip fracture sustained from a ground-level fall. Staff at participating hospitals identified patients with musculoskeletal injury and referred them for assessment of eligibility. We report time from injury to surgery as three distinct time periods: time from injury to hospital admission, time from admission to surgery, and a total time from injury to surgery. Date and time of injury were self-reported by patients at the time of study recruitment. If time to hospital admission after injury exceeded 24 h, patients reported the primary reason for delayed admission. Reasons for surgery, no surgery, and surgical delay were reported by the treating team. For patients undergoing surgery, multivariable regression analyses were used to identify risk factors for surgical delay.

4486 adults aged 50 years or older with an isolated, primary hip fracture were enrolled in INORMUS from 55 hospitals in 24 countries. Countries were grouped into five regions: Africa (418 [9·3%] of 4486), Latin America (558 [12·4%]), China (1680 [37·4%]), India (1059 [23·6%]) and Asia (excluding China and India; 771 [17·2%]). Of 4486 patients, 3805 (84·8%) received surgery. The rate of surgery was similar in all regions except in Africa, where only 193 (46·3%) of 418 patients had surgery. Overall, 2791 (62·2%) of 4486 patients were admitted to hospital within 24 h of injury. However, 1019 (22·7%) of 4486 patients had delayed hospital admission of 72 h or more from injury. The two most common reasons for delayed admission of more than 24 h were transfer from another hospital (522 [36·2%] of 1441) and delayed care-seeking because patients thought the injury would heal on its own (480 [33·3%]). Once admitted to hospital, 1451 (38·1%) of 3805 patients who received surgery did so within 72 h (median 4·0 days [IQR 1·7-6·0]). Regional variation was seen in the proportion of patients receiving surgery within 72 h of hospital admission (92 [17·9%] of 514 in Latin America, 53 [27·5%] of 193 in Africa, 454 [30·9%] of 1471 in China, 318 [44·4%] of 716 in Asia [excluding China and India], and 534 [58·6%] of 911 in India). Of all 3805 patients who received operative treatment, 2353 (61·8%) waited 72 h or more from hospital admission. From time of injury, the proportion of patients who were surgically stabilised within 72 h was 889 (23·4%) of 3805 (50 [9·7%] of 517 in Latin America, 31 [16·1%] of 193 in Africa, 277 [18·8%] of 1471 in China, 189 [26·4%] of 716 in Asia [excluding China and India], and 342 [37·5%] of 911 in India).

Access to surgery within 72 h of hospital admission was poor, with factors that affected time to surgery varying by region. Data are necessary to understand existing pathways of hip-fracture care to inform the local development of quality-improvement initiatives.

The National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, McMaster Surgical Associates, Hamilton Health Sciences, and the US National Institutes of Health.

Timing of surgery remains a topic of debate for hip fracture treatment in the geriatric patient population. The quality indicator "early surgery" was implemented in 2014 at the Department of Trauma Surgery of the University Hospitals Leuven to enhance timely operative treatment. In this follow-up study, we aim to evaluate the performance of this quality indicator, the clinical outcomes, and room for improvement.

The charts of 1190 patients surgically treated for an acute hip fracture were reviewed between June 2017 and May 2022 at the University Hospitals Leuven. Primary endpoints were adherence to early surgery, defined as surgery within the next calendar day, and the evaluation of the reasons for deviating from this protocol. Secondary endpoints were length of stay (LOS); intensive care unit (ICU) admission and length of ICU stay; mortality after 30 days, 60 days, 90 days, and 6 months; and 90-day readmission rate. Pearson's Chi-square test and Mann-Whitney U test were used for data analysis.

One thousand eighty-four (91.1%) patients received early surgery versus 106 (8.9%) patients who received delayed surgery. The main reasons for surgical delay were the use of anticoagulants (33%), a general health condition not allowing safe surgery and/or existing comorbidities requiring workup prior to surgery (26.4%), and logistical reasons (17.9%). Patient delay and transfer from other hospitals were responsible for respectively 8.5% and 6.6% of delayed surgery. Early surgery resulted in a significantly shorter LOS and ICU stay (12 [8-25] vs. 18 [10-36] and 3 [2-6] vs. 7 [3-13] days, early vs. delayed surgery, respectively). No significant reduction was observed in ICU admission, mortality, and readmission rate.

We have been able to maintain the early surgery hip fracture protocol in approximately 90% of the patients. Comorbidities and anticoagulant use were responsible for delayed surgery in the majority of the patients. Correct implementation of the existing protocol on anticoagulant use could lead to a one-third decrease in the number of delayed surgeries. Subsequently, since the LOS and ICU stay in the delayed surgery group were significantly longer, a further increase of early surgery will lower the current economic burden.

Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events.

Registry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes.

2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1-2.3)) and one-year mortality (AOR 1.4 (1.1-1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3-0.9)), but a similar one-month mortality to DOAC-patients operated under SA.

DOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.

Hip fracture is a common injury in older adults; however, the optimal timing of surgical treatment remains undetermined in Japan. Therefore, this retrospective study aimed to ascertain the rate of early surgery among hip fracture patients and investigate its effectiveness, along with "regional clinical pathways" (patient plan of care devised by Japanese clinicians), in reducing the length of hospital stay (LOS) postoperatively. We hypothesized that performing early surgery along with a regional clinical pathway is effective to reduce the postoperative LOS and complications among hip fracture patients. We examined the data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese Diagnosis Procedure Combination database between April 2016 and March 2018. Patients were divided into the early (43,928, 34%; surgery within 2 days of admission) and delayed (84,237, 66%; surgery after 2 days of admission) surgery groups. The difference in postoperative LOS between the two groups was 3 days (early vs. delayed: 29 days vs. 32 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than did the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anemia (12% vs. 8.8%). Logistic regression analysis using the adjusted model revealed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p<0.001). Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative LOS, allowing regional clinical pathways to have a greater impact. These findings will help acute care providers when treating hip fracture patients.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (benefits and harms) of ultra-early versus early surgery for hip fracture in adults.

The comparative results of early hip fracture surgery including mortality and postoperative complications in Thailand were not reported. Therefore, we conducted this study to compare the outcomes between patients who received hip surgery within and after 24 hours.

A retrospective study was conducted at a single center, a tertiary private hospital in Thailand. The medical records of patients who were admitted from 2018 to 2020 were reviewed. Patients aged <50 years, high-energy fracture, pathological fractures, or multiple traumas were excluded. The patients were categorized into two groups for comparison: surgery within and surgery after 24 hours groups. The outcome measures were in-hospital, 30-day, and 1-year mortality rates, length of stay, and the incidences and severities of postoperative complications.

A total of 276 hip fracture patients were analyzed, with the majority (77.9%) undergoing surgery within 24 hours. Patients who underwent earlier surgery had a significantly shorter hospital stay [6 (4, 9) vs 8 (7, 13) days, P < .001]. The cumulative mortality rates at in-hospital, 30 days, and 1 year were 0%, 1.1%, and 2.5%, respectively. The most common postoperative complications observed were anemia (43.1%) and acute kidney injury (32.6%). However, there were no statistically significant differences in mortality rates (P > .05) or postoperative complications (P = .410) between the two groups.

While surgery within 24 hours showed some benefits, such as a shorter hospital stay and reduced pain rescue, it did not reduce mortality or major complications in hip fracture patients.

Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED).

A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates.

 Frailty, serum lactate > 2, and presentation to the ED > 12 hours after injury were significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively. Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions.

Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.

Current U.S./Canadian guidelines recommend hip fracture surgery within 48 h of injury to decrease morbidity/mortality. Multiple studies have identified medical optimization as the key component of time to surgery, but have inherent bias as patients with multiple co-morbidities often take longer to optimize. This study aimed to evaluate time from medical optimization to surgery (TMOS) to determine if "real surgical delay" is associated with: 1) mortality and 2) complications for geriatric hip fracture patients.

A retrospective chart review of geriatric hip fractures treated from 2015-2018 at a single, level-1 trauma center was conducted. Univariate logistic regression was performed to identify association between TMOS and post-operative complication rates. For mortality, the Wilcoxon test was used to compare TMOS for patients discharged following surgery to those who were not.

A total of 884 hip fractures were treated operatively, with median TMOS 16.2 h (5.0-22.5, 1st-3rd quartiles). Univariate logistic regression models did not identify an association between TMOS and complication rates. For patients successfully discharged, median TMOS was 16.2 h (5.0-22.3, 1st-3rd quartiles). For the cohort of patients not successfully discharged, median TMOS was 19.1 h (10.1-25.9, 1st-3rd quartiles, p = 0.16).

"Real surgical delay", or TMOS is not associated with increased complications or with inpatient mortality for geriatric hip fracture patients. With few exceptions, our institution adhered to the 48-hour time window from injury to hip surgery. We maintain the belief timely surgery following optimization plays a crucial role in the geriatric hip fracture patient outcomes.

Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between 10 and 38%, a wide margin, and confounded by multiple factors including age, high energy mechanisms, pathological and periprosthetic fractures. The purpose of this study was to assess and determine all-cause mortality following geriatric native distal femur fractures at 30 days, six months and one year.

- The databases Cochrane CENTRAL, MEDLINE, EMBASE and NHS NICE Healthcare Databases Advanced Search Interface were searched in accordance with PRISMA guidelines. Original research articles relevant to mortality outcomes in native geriatric distal femur fractures following low energy trauma were included. A time-to-event data meta-analysis model was used to estimate pooled 30-day, six month and one-year mortality. A random effects meta-regression model was performed to assess potential sources of heterogeneity when studies reported on factors affecting the mortality observed in patients with geriatric distal femur fractures.

- Thirteen studies were included in the meta-analysis with a mean age of 79.6 years. Eight studies reported the 30-day mortality of distal femur fractures in patients as a pooled estimate of 8.14%. Pooled estimate for 6-month mortality reported was 19.5% and the one-year mortality reported by ten studies was 26.10%. Time-to-event modelling showed that risk of mortality at one year in elderly patients with distal femur fractures was significantly higher HR = 4.31 (p < 0.001). When evaluating prognostic predictors, age and Type C fracture were predictive of highest mortality rates.

- This study is the first meta-analysis to evaluate the early and long-term mortality observed in elderly patients presenting with native distal femoral fractures. Through our results we have shown the quantifiable impact patient age and fracture configuration has on one-year mortality in this patient cohort.

Proximal femoral fractures in aging populations represent a significant concern, with an increasing prevalence among individuals aged ≥100 years. The existing research does not provide robust guidance for clinicians managing older patients aged ≥100 years with proximal femoral fractures. We investigated the safety and efficacy of surgical treatment in patients aged ≥100 years with proximal femoral fractures and evaluated the impact of early surgery on their outcomes.

This retrospective cohort study involved 15 patients aged ≥100 years who underwent surgical treatment of proximal femoral fractures; the control group included 137 patients in their 90s. Data were collected between January 2010 and December 2017. Evaluation items included patient characteristics, surgical details, perioperative complication rates, length of hospital stay, the proportion of patients discharged to the same facility or home, rate of regaining walking ability, and 1-year survival rate.

The patients aged ≥100 years and those in their 90s had comparable outcomes. Thus, age alone does not dictate surgical success. Early surgery (≤48 h) was associated with trends toward improved perioperative complications, ambulatory ability, and return to original living environment.

This study underscores the potential benefits of surgical intervention for proximal femoral fractures in patients aged ≥100 years, indicating the relevance of early surgery (≤48 h). Our findings emphasized the importance of timely intervention and evidence-based decision-making for this demographic. Clinicians, policymakers, and patients could benefit from our insights to enhance fracture management strategies, along with future research endeavors to validate and expand our results in larger multicenter cohorts.

Hip fracture patients are recommended to undergo surgery within 24-36 h. The present study aimed to analyze the current status of hip fracture surgery among the elderly in China.

The baseline information, such as the patient's age, gender, place of residence, place of treatment, fracture type, admission, and operation time, of hip fracture patients >65-years-old were retrieved from the hospital quality monitoring system (HQMS) database from 2013 to 2017 and analyzed.

A total of 304,279 patients >65-years-old with hip fractures were included in this study. The average length of hospital stay was 15 days, and the average waiting time for surgery after admission was 96 h. The average surgery rate of elderly hip fractures in China was 59.6 %, of which the lowest was recorded in the Northwest China (46.4 %).

The major issues in diagnosing and treating elderly patients with hip fractures in China are the long waiting time for surgery and the low surgery rate.

Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer's disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD.

This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients' demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups' post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates.

Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, P < 0.05).

The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures.

The aim of this systematic review was to assess the impact of time to surgery on patient mortality, peri-operative complication rates and length of stay following a hip fracture using level one data.

Multiple databases (PubMed, Embase, Medline (Ovid), and Cochrane Library) were searched using terms for "hip fracture" and the intervention "early surgery". Results were filtered to only included randomised controlled trials in the English language published from the year 2000.

All results were imported into Covidence and screened by two separate reviewers with conflicts resolved by a third reviewer. Studies were included if they reported data on the relationship between time to theatre and at least one of the outcome measures (mortality, peri-operative complications, and length of stay in hospital). Three papers were finalised to include in this review.

Once selected, each paper had a bias assessment completed by two separate reviewers using the Cochrane RoB2 tool. Any conflicts were resolved by a third reviewer.

Data from each paper were inputted into RevMan5 for analysis. Approximated sample mean and standard deviation were collected from each paper and included for analysis. RevMan5 was then used to generate forest plots and report data on relative risk and mean difference.

This review has shown that accelerated care of patients with hip fractures was associated with lower risks of delirium and infection, and a shorter length of hospital stay. However, the effect of time to surgery on patient mortality is not clear, as the standard care group had a lower mortality than expected for the population at risk and had surgery on average within 24-h of presentation.

Surgery within 24 hours after a hip fracture improves patient morbidity and mortality, which has led some hospitals to launch quality improvement programs (eg, targeted resource management, documented protocols) to address delays. However, these programs have had mixed results in terms of decreased time to surgery (TTS), identifying an opportunity to improve the effectiveness of interventions.

To identify the contextual determinants (site-specific barriers and facilitators) of TTS for patients with hip fracture across diverse hospitals.

This qualitative mixed-methods study used an exploratory sequential design that comprised 2 phases. In phase 1, qualitative semistructured interviews were conducted with stakeholders involved in hip fracture care (orthopedic surgeons or residents, emergency medicine physicians, hospitalists, anesthesiologists, nurses, and clinical or support staff) at 4 hospitals with differing financial, operational, and educational structures. Interviews were completed between May and July 2021. In phase 2, a quantitative survey assessing contextual determinants of TTS within 24 hours for adult patients with hip fracture was completed by orthopedic surgeon leaders representing 23 diverse hospitals across the US between May and July 2022. Data analysis was performed in August 2022.

Thematic analysis of the interviews identified themes of contextual determinants of TTS within 24 hours for patients with hip fracture. The emergent contextual determinants were then measured across multiple hospitals, and frequency and distribution were used to assess associations between determinants and various hospital characteristics (eg, setting, number of beds).

A total of 34 stakeholders were interviewed in phase 1, and 23 surveys were completed in phase 2. More than half of respondents in both phases were men (19 [56%] and 18 [78%], respectively). The following 4 themes of contextual determinants of TTS within 24 hours were identified: availability, care coordination, improvement climate, and incentive structure. Within these themes, the most commonly identified determinants across the various hospitals involved operating room availability, a formal comanagement system between orthopedics and medicine or geriatrics, the presence of a physician champion focused on timely surgery, and a program that facilitates improvement work.

In this study, contextual determinants of TTS within 24 hours for patients with hip fracture varied across hospital sites and could not be generalized across various hospital contexts because no 2 sites had identical profiles. As such, these findings suggest that guidance on strategies for improving TTS should be based on the contextual determinants unique to each hospital.

» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a "orthogeriatric" team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients.

A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients.

Functional Independence Measure (FIM) and the motor FIM's effectiveness.