Effects of Capacity-Related Delay to Hip Fracture Surgery on Mortality: A Matched-Cohort Study.

Summary

In 2,358 older adults undergoing operative hip-fracture treatment, 54% experienced surgery delayed beyond 36 hours because of operative-capacity constraints rather than medical optimization. After propensity-score matching, capacity-related delay was associated with higher 365-day mortality (HR 1.37, 95% CI 1.15-1.63), with the greatest early effect within 30 days (HR 1.71, 95% CI 1.11-2.65); frailer patients were particularly vulnerable.

Key Findings

• Among 2,358 eligible patients, 46% received timely surgery and 54% experienced capacity-related delay.
• After propensity-score matching, capacity-related delay was associated with higher 365-day mortality (HR 1.37, 95% CI 1.15-1.63).
• The mortality effect was strongest during the first 30 days, and patients with Clinical Frailty Scale scores above 4 were most affected.

Clinical Implications

Hospitals should monitor capacity-related surgical delays separately from delays for medical optimization and consider expedited operating-room access for frail patients with hip fractures. The study supports system-level quality-improvement interventions, although it does not prove that reducing delay alone will lower mortality.

Limitations

• The retrospective single-hospital design limits generalizability and cannot establish causality.
• Residual confounding, including unmeasured system and patient factors, may remain despite matching.

Future Directions

Prospective multicenter studies should evaluate whether reducing capacity-related delay through dedicated trauma pathways, protected operating-room capacity, or regional coordination improves mortality and functional recovery, with particular attention to frailty-stratified effects.