Moderate evidence supports that hip fracture surgery within 48 hours of admission is associated with better outcomes.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Nine moderate strength studies evaluated patient outcomes in relation to timing of hip fracture surgery (Elliot et al 25, Fox et al 26, McGuire et al 27, Moran et al 28, Novack et al 29, Orosz et al 30, Parker et al 31, Radcliff et al 32, Siegmeth et al 33). In many of these studies the presence of increased comorbidities represented a confounding effect, and therefore delays for medical reasons were often excluded.
The majority of studies favored improved outcomes in regards to mortality, pain, complications, or length of stay (Elliot et al 25, McGuire et al 27, Novack et al 29, Orosz et al 30, Parker et al 31, and Siegmeth et al 33). Although several studies showed a benefit of surgery within 48 hours, one study showed no harm with a delay up to four days for patients fit for surgery who were not delayed for medical reasons (Moran et al 28). Patients delayed due to medical reasons had the highest mortality and it is this subset of patients that could potentially benefit the most from earlier surgery.
Risks and Harms of Implementing this Recommendation
There are no known harms associated with implementing this recommendation.
Future Research
Future research improving controls for bias relating to increased medical severity of patients delayed for surgery is needed to better identify critical timing related issues regarding patient specific populations.
  1. (25) Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 2003;56(8):788-795.
  2. (26) Fox HJ, Pooler J, Prothero D, Bannister GC. Factors affecting the outcome after proximal femoral fractures. Injury 1994;25(5):297-300.
  3. (27) McGuire KJ, Bernstein J, Polsky D, Silber JH. The 2004 Marshall Urist award: delays until surgery after hip fracture increases mortality. Clin Orthop Relat Res 2004;(428):294-301.
  4. (28) Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005;87(3):483-489.
  5. (29) Novack V, Jotkowitz A, Etzion O, Porath A. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 2007;19(3):170-176.
  6. (30) Orosz GM, Magaziner J, Hannan EL et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291(14):1738-1743.
  7. (31) Parker MJ, Pryor GA. The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 1992;74(2):203-205.
  8. (32) Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 2008;90(1):34-42.
  9. (33) Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 2005;87(8):1123-1126.