Early Morbidity but not Mortality Increase with Surgery Delayed Greater Than 24 Hours in Patients with a Periprosthetic Fracture of the Hip

Abstract Introduction Studies have identified a possible morbidity and mortality benefit with expedited time to surgery after a native hip fracture. This association after hip periprosthetic fractures (PPF) has been less clearly delineated. The purpose of this study is to assess the effect of time to surgery on rates of thirty-day complications. Methods The National Surgical Quality Improvement Program registry was utilized to identify all patients who underwent surgical intervention for hip PPF between 2005-2016.. Patients were stratified into two cohorts based on time from hospital admission to surgery, either ≤24 hours (expedited) or >24 hours (non-expedited). Thirty-day outcome variables were assessed using bivariate and multivariate analysis. Results We identified 857 patients undergoing surgical intervention for hip PPF, of whom 402(46.9%) underwent expedited surgery and 455(53.1%) underwent non-expedited surgery. Patients with non-expedited surgery had an average time to surgery of 2.4 days (range 1-14 days). Multivariate analysis adjusting for differences in baseline patient characteristics revealed that patients with a non-expedited procedure had higher rates of overall complications (Odds Ratio [OR]=1.72, p =0.014), respiratory complications (OR=4.15, p =0.0029), urinary tract infections (OR=2.77, p =0.020), non-home discharge (OR=2.22, p p p =0.093). Patients with non-expedited surgery also had longer total and post-operative (+2.7 days, p Conclusions This study did not identify any statistical difference in mortality but found an association with increased postoperative complications and non-expedited surgery for PPF. Additional prospective studies may be warranted to identify the causative factors behind this association.