Suresh K. Nayar - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Majd Marrache - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Jarred A. Bressner - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Micheal Raad - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Babar Shafiq - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Uma Srikumaran - Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA

Background: Surgical fixation of hip fractures within ۲۴–۴۸ hours of hospital presentation is associated with decreased rates of postoperative morbidity and death, and recently, hospitals nationwide have implemented strategies to expedite surgery. Our aim was to describe how time-to-surgery and short-term complication rates have changed using the National Surgical Quality Improvement Program database from ۲۰۱۱ to ۲۰۱۷. Methods: We identified more than ۷۳,۰۰۰ patients aged ≥۶۵ years who underwent surgical fixation. Poisson regression adjusting for comorbidities, surgery type, type of anesthesia, patient sex, and patient age was performed to quantify annual changes in time-to-surgery. Annual changes in ۳۰-day postoperative complications were analyzed using a generalized linear model with binomial distribution. Results: A significant decrease in time-to-surgery was observed during the study period (mean ۳۰ hours in ۲۰۱۱ versus ۲۶ hours in ۲۰۱۷; P<۰.۰۰۱). Time-to-surgery decreased by ۲% annually during the ۷-year period (۰.۵ hour/year, ۹۵% CI: -۳۵, -۲۳; P<۰.۰۰۱). The all-cause ۳۰-day complication rate also decreased annually (annual risk difference: −۰.۳۵%, ۹۵% CI: −۰.۵۰%, −۰.۲۰%; P<۰.۰۰۱). For individual complications, we found significant decreases in deep infection (-۰.۲%, P=۰.۰۰۲), reintubation (-۰.۳%, P=۰.۰۰۱), urinary tract infection (-۲.۵%, P<۰.۰۰۱), and death (-۱.۳%, P=۰.۰۳). We found significant but small increases of pulmonary embolism (۰.۳%, P=۰.۰۳) and myocardial infarction (۰.۱%, P=۰.۰۲). Higher rates of complications were associated with increased time-to-surgery (P<۰.۰۰۱). Conclusion: From ۲۰۱۱ to ۲۰۱۷, time-to-surgery for hip fracture decreased significantly, as did short-term postoperative rates of all-cause complications and death. Longer time-to-surgery was associated with increased number of complications. Level of evidence: III

Complications, Hip fracture, National Surgical Quality Improvement Program, surgical fixation