Clinical effects of surgical delay in older patients with intertrochanteric fractures: analysis from the National Inpatient Sample Database

INTRODUCTION: The clinical effect of surgical timing in older patients with intertrochanteric fractures is controversial. Our objective was to assess the association between surgical timing and in-hospital mortality and postoperative complications in these patients. MATERIALS AND METHODS: IFs patients accepted internal fixation surgery were obtained from the 2002 to 2014 Nationwide inpatient sample database. They were categorized into 3 subgroups according to the time of admission to surgery: early (within 24 h), shorter delays (1 to 2 days), and longer delays (3 to 7 days). The chi-squared test and Kruskal-Wallis test were performed to measure differences among these 3 subgroups. Survey-weighted methods accounted for the complex sampling design. Multiple logistic regression and mixed-effects models were utilized to calculate odds ratios and 95% confidence intervals. RESULTS: A total of 228,725 patients were obtained from the NIS database. The prevalence of internal fixation surgery in IF patients significantly increased over time. Delayed surgery was associated with longer length of stay, higher hospital charges, and higher risk of postoperative complications. Rates of in-hospital death were 2.110% and 4.214%, respectively in two delay groups. After adjustment, shorter delays were not associated with in-hospital death (OR: 1.007; 95% CI: 0.937-1.082; P = 0.859), whereas longer delays were obviously associated with a higher risk of death during hospitalization (OR: 1.348; 95% CI: 1.218-1.492; P < 0.001). Sensitivity analyses using alternative definitions of time-to-surgery yielded consistent results. CONCLUSIONS: In this study, prolonged waiting time for surgery was significantly associated with a higher risk of adverse in-hospital events. Reasonable preoperative optimization and strive for early surgery may be necessary.