Surgical Timing
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

Rationale
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.
 

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