# The effect of time to surgery on clinical outcomes and hospitalization costs in older adults with femoral shaft fractures: A nationwide retrospective cohort study in Japan

## TL;DR

This study found that early surgery for femoral shaft fractures in older adults in Japan reduces complications and costs, but does not significantly affect mortality.

## Contribution

The study provides new evidence on the impact of early surgery on clinical outcomes and costs for older adults with femoral shaft fractures in Japan.

## Key findings

- Early surgery was associated with lower odds of pneumonia and urinary tract infections.
- Early surgery reduced postoperative hospital stays by about 5 days.
- Hospitalization costs were significantly lower with early surgery.

## Abstract

This study aimed to evaluate the effect of early surgery on clinical outcomes and hospitalization costs in older adults with femoral shaft fractures.

We conducted a retrospective cohort study using a nationwide administrative database in Japan, including patients aged 65 years and over who underwent surgery for femoral shaft fractures between 2014 and 2023. Early surgery was defined as surgery performed on the day of admission or the day after admission. We applied inverse probability of treatment weighting (IPTW) using propensity scores to adjust for confounding. Multiple imputation by chained equations was performed to impute missing data. The primary outcome was in-hospital mortality; secondary outcomes included complications, length of postoperative hospital stay, and hospitalization costs.

Among 11,087 eligible patients, 3,170 (28.6%) received early surgery. After IPTW adjustment, there was no significant difference in in-hospital mortality (odds ratio (OR), 0.96; 95% confidence interval (CI), 0.66–1.41). However, early surgery was associated with significantly lower odds of pneumonia (OR, 0.64; 95% CI, 0.44–0.94) and urinary tract infection (OR, 0.66; 95% CI, 0.48–0.90), shorter postoperative hospital stay (mean difference, 5.37 days; 95% CI, 3.56–7.19), and reduced hospitalization costs (mean difference, 150,380 Japanese yen; 95% CI, 93,270–207,490).

Early surgery for femoral shaft fractures in older adults was not associated with a significant reduction in in-hospital mortality compared to delayed surgery. However, it was associated with fewer complications, shorter postoperative hospital stays, and reduced hospitalization costs. These findings suggest that early surgery may be beneficial for improving postoperative recovery.

The online version contains supplementary material available at 10.1007/s00068-026-03106-7.