What is the association between time to surgery and patient outcome after hip fracture?

Aims: Performance indicators are used to evaluate the quality of healthcare provided to hip fracture patients. 'Time to surgery' describes the delay between the patient's injury or presentation to hospital and their hip fracture surgery, and is one of the most commonly reported performance indicators. In this review, we investigated the association between time to surgery and patient outcomes following hip fracture. Methods: A total of 12 electronic databases and other sources were searched and the methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO (ID CRD42023417515). Results: In total, 24,791 articles were reviewed, and 139 studies were included involving 4,336,707 patients aged 50 years or older with a hip fracture. There were two randomized clinical trials, one case control study, six pre-/post-intervention studies, and 130 cohort studies, conducted in 36 countries between 1980 and 2022. The definition of time to surgery varied across studies and health systems, making formal meta-analysis of the data impossible. Surgery within 48 hours of injury/hospitalization was associated with improved mobility, functional status, more patients being discharged to their preinjury residence, and reduction in complications, costs, length of hospital stay, readmissions, and mortality. Surgery within 24 hours of injury/hospitalization was associated with all of the above, as well as fewer reoperations and improved quality of life. Conclusion: Early surgery for hip fracture in older people is associated with better clinical and patient-reported outcomes. Standardization of the definition of 'early' surgery and consistent reporting of 'time to surgery' would improve future evidence synthesis.