Factors Associated With Time to Surgery of Geriatric Hip Fractures: An Analysis of the American College of Surgeons' Trauma Quality-Improvement Program Database.

Zhuang T, Shapiro LM, Koltsov JCB, Harris AHS, Baker LC, Morris A, Gardner MJ, Tennakoon L, Spain DA, Kamal RN. Factors Associated With Time to Surgery of Geriatric Hip Fractures: An Analysis of the American College of Surgeons' Trauma Quality-Improvement Program Database. The Journal of The American Academy of Orthopaedic Surgeons. 2025 Oct 2 DOI: 10.5435/JAAOS-D-24-01492.

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Abstract:

INTRODUCTION: Increased time to surgery (TTS) for geriatric patients with hip fractures is independently associated with increased risk of perioperative morbidity and mortality. Facility and patient-level variables associated with time to surgery have not been fully described. In this study, we aimed to determine the facility and patient factors associated with TTS for patients 65 years with hip fractures to inform strategies for reducing TTS. METHODS: Using the American College of Surgeons (ACS) Trauma Quality Improvement Program database, we identified 65,512 patients 65 years who underwent hip fracture surgery during 2017 to 2018 at ACS-verified level I-III trauma centers. Facility and patient factors, including trauma center level, teaching hospital status, hospital size, age, sex, race, comorbidities, and injury severity score were recorded. The primary outcome was time to surgery, defined as the time from emergency department or hospital arrival to surgery (in hours). RESULTS: Of 65,512 eligible patients, 37,782 (57.7%) and 58,732 (89.7%) received surgery within 24 and 48 hours of arrival, respectively. In the multivariable analysis, male sex and Black race were associated with a 5% (95% CI: 4 to 7%) and 14% (95% CI: 8 to 20%) increase in TTS, respectively. Anticoagulant therapy (+25% [95% CI: 22 to 28%]), bleeding disorder (+19% [95% CI: 12 to 26%]), and congestive heart failure (+16% [95% CI: 13 to 19%]) were also associated with increased TTS. An increase in TTS of 12 hours was independently associated with 14% (95% CI: 12 to 16%), 15% (95% CI: 13 to 16%), and 8% (95% CI: 2 to 15%) increase in the odds of experiencing any hospital complication, a general medical complication, and return to the OR. DISCUSSION: Patient, but not facility, factors were associated with increased TTS for geriatric patients with hip fractures. Further research is needed to describe the general and context-specific determinants (eg, inefficient transfer processes, OR staffing) of TTS for hip fractures.