Article ID: 27003
Background: The effect of early surgery for hip fractures may vary depending on patients’ pre-fracture physical and cognitive function. We aimed to examine whether the association between early surgery for hip fracture and one-year mortality differs by patients’ pre-fracture functional status, assessed using care need levels defined by Japan’s nationally standardized certification system.
Methods: This retrospective cohort study used medical and long-term care insurance databases from Tochigi Prefecture, Japan. Inpatients with hip fractures aged ≥ 65 years between June 2014 and October 2018 were included. Patients were categorized into no care needs or one of the seven care need levels (support level 1–2 or care need level 1–5), each corresponding to specific estimated daily care minutes. Early surgery was defined as surgery on day 1 or 2 of admission, and delayed surgery as surgery between days 3 and 7. Propensity score weighting and logistic regression were used to compare one-year mortality between early and delayed surgery groups in the overall cohort and within each pre-fracture care need level.
Results: Among 922 patients in the early surgery group and 2,680 in the delayed surgery group, adjusted one-year mortality was 16.2% and 14.4%, respectively (risk difference, 1.8%; 95% confidence interval, -1.2 to 4.8%). No significant differences in one-year mortality were observed between early and delayed surgery groups within any pre-fracture care need level stratum.
Conclusions: Early surgery was not associated with reduced one-year mortality in patients with hip fractures, either overall or when stratified by pre-fracture care need level.
