# The Impact of Surgical Timing and Perioperative Factors On In-Hospital Mortality Following Femur Fracture Surgery: A Retrospective Cohort Study From Bahrain

## TL;DR

This study finds that older age, delayed surgery, and poor health are linked to higher in-hospital death rates after femur fracture surgery in older adults.

## Contribution

The study identifies specific perioperative factors associated with mortality in femur fracture surgery patients in a Bahraini setting.

## Key findings

- Advanced age, surgical delay, and physiological decline were independent predictors of in-hospital mortality.
- A crude mortality rate of 8.9% was observed in the cohort.
- Expedited surgery and perioperative optimization are recommended to improve outcomes.

## Abstract

Background and objective

Femur fractures in older adults pose a significant clinical challenge, often necessitating urgent surgical intervention and meticulous perioperative management. Various patient- and treatment-related factors potentially influence postoperative outcomes and in-hospital mortality. This study aimed to identify variables associated with adverse outcomes following femur fracture surgery.

Methods

We conducted a retrospective cohort study of consecutive patients who underwent femur fracture surgery at a tertiary care center. Data were extracted from an institutional registry and included demographic characteristics (age and sex), process measures (time to surgery and reasons for surgical delay), clinical variables (fracture type and anesthesia), physiological markers (preoperative and postoperative hemoglobin (Hb), and outcomes (ICU admission, early mobilization, length of stay, and in-hospital mortality). Descriptive statistics were used to summarize the cohort data. Exploratory bivariate analyses and multivariable logistic regression models were performed to identify independent predictors of in-hospital mortality. Prespecified figures were used to illustrate age distribution, sex composition, surgical timing, ICU admission, hospital stay, and Hb changes.

Results

The analytic cohort comprised 89 patients, with a mean age of 76.8 years (standard deviation (SD): 9.1 years); 37.1% were male. The mean time from admission to surgery was 4.2 days, with an average perioperative Hb decline of 1.47 g/dL. In-hospital mortality status was available for 79 patients, revealing a crude mortality rate of 8.9%. Unadjusted analyses demonstrated that patients experiencing surgical delays and requiring ICU admission were more likely to die in the hospital. Multivariable modeling identified older age, surgical delay, and physiological decompensation as independent predictors of mortality.

Conclusions

In this single-center retrospective cohort, advanced age, delayed surgery, and physiological decline were significantly associated with adverse outcomes, including ICU admission, prolonged hospitalization, and in-hospital mortality. These findings highlight the necessity for expedited surgery, standardized perioperative optimization, and multidisciplinary co-management in femur fracture care. Future prospective studies with longer follow-up are warranted to validate these associations.