Hip Fractures in Malta: Does Delay in Surgery Affect Clinical Outcomes?

Abstract

Introduction: 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.

Methodology: 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.

Results: 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.

Conclusions: 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.

Keywords: covid 19; fragility hip fractures; length of hospital stay (los); mortality rate; revision surgery; surgical delay.

Figure 1. Flowchart of the study population selection process.