Clinical Effects of Surgical Delay in Older Patients with Intertrochanteric Fractures: Analysis from the National Inpatient Sample Database

The clinical effect of surgery timing in older patients with intertrochanteric fractures (IFs) is controversial. Our objective was to assess the association between surgery timing and in-hospital mortality and postoperative complications in these patients. In our study, 228,725 patients accepted internal fixation surgery for IFs were obtained from the 2002 to 2014 Nationwide inpatient sample (NIS) database. They were categorized into 3 subgroups according to the time of admission to surgery: early, shorter delays, and longer delays. The prevalence of internal fixation surgery in IFs patients significantly increased over time. Delays in surgery were associated with longer LOS, extra hospital charges, and higher risk of postoperative complications. Rates of in-hospital death were 2.110% and 4.214%, respectively in two delay groups. After adjustment, shorter delays was not associated with in-hospital death (OR: 1.024, CI: 0.953, 1.088;P = 0.520), longer delays was obviously associated with an increased risk of death during hospitalization (OR: 1.547, CI: 1.410, 1.696;P<0.001). Prolonged waiting time for surgery significantly increased the risk of developing adverse events. Therefore, reasonable preoperative optimization and strive for early surgery are necessary.