Management of fractures of the hip in older patients Timing of surgery and mortality

A retrospective analysis carried out for the period 1975–91 revealed, that 667 patient underwent surgery for fracture of the proximal femur. The predominantly female group was on average 77.7 (range 54–99) years old. The largest group was operated on the second day of their hospital stay, while the majority (591 or 88.6%) were managed during the first week. Of these 591 patients, 62 (10.5%) died during the evaluation period, while 19.7% (n=15) of the 76 patients operated after the first week did not survive. The comparision of the mortality associated with immediate surgery (5.2%) and surgery during the first week (11.3%) did not reveal a significant difference. The difference between the group operated during the first week (mortality rate: 10.5%) and those operated in the second week (23.8%) proved to be significant. This retrospective study, could not confirm a positive influence of immediate surgery on the mortality rate. Critical in regard to survival of patients proved to be a delay of surgery beyond the seventh day. In an older population, the fracture of the proximal femur represents a complex disease process requiring meticulous preoperative preparation. Especially in light of concurrent medical conditions, an optimal state of health going into surgery seems advantageous.