Delayed hospitalization for patients with hip fragility fracture increases mortality risk one year after surgery: a multicentre cohort study

PURPOSE: To determine whether delay from fracture to hospital admission is associated with 1-year mortality after osteoporotic hip fracture surgery. METHODS: In this multicenter retrospective cohort study, 1,733 patients aged ≥ 50 years who underwent surgery for osteoporotic hip fracture were analyzed. Time from fracture to admission, admission to surgery, and fracture to surgery were recorded. Cox regression was used to estimate adjusted hazard ratios (HRs) for 1-year mortality. RESULTS: One-year mortality was 6.66%. Longer delay from fracture to admission was independently associated with higher mortality: each additional day increased risk by 6% (adjusted HR 1.06, 95% CI 1.04–1.08; P < 0.001). Patients admitted more than 1 day after fracture had a 44% higher mortality risk than those admitted within 1 day (HR 1.44, 95% CI 1.22–1.71; P < 0.001). Admission beyond 4 days was associated with a twofold increase in mortality (HR 2.01, 95% CI 1.66–2.43; P < 0.001). Time from admission to surgery was not associated with mortality, whereas longer time from fracture to surgery was (per-day HR 1.03, 95% CI 1.02–1.05; P < 0.001; >7 vs. ≤ 7 days: HR 1.46, 95% CI 1.23–1.73; P < 0.001). CONCLUSION: Prehospital delay is an independent predictor of one-year mortality, with risk escalating sharply beyond 4 days. Prioritizing early admission over in-hospital speed may improve survival. For patients with osteoporotic hip fractures, each day of delay in hospitalization increases one-year mortality risk by 6%. This study identifies delayed admission as a key risk factor, highlighting that optimizing referral pathways to reduce pre-hospital delays may improve survival. TRIAL REGISTRATION: Not applicable for this observational study.