# Impact of Early Surgery on Clinical Outcomes of Super‐Aged Patients With Hip Fractures: A Retrospective Propensity Score‐Matched Study With 2‐Year Follow‐Up

## TL;DR

Early surgery within 48 hours for hip fractures in patients aged 80+ improves survival and reduces complications, hospital stay, and costs.

## Contribution

Demonstrates that early surgery in super-aged hip fracture patients significantly improves clinical outcomes and resource utilization.

## Key findings

- Early surgery reduced 1-year and 2-year mortality rates compared to non-early surgery.
- Early surgery decreased postoperative complications like pneumonia and delirium.
- Early surgery led to shorter hospital stays and lower hospitalization costs.

## Abstract

The global aging population has led to a significant increase in hip fractures among elderly patients, posing substantial clinical challenges. While early surgical intervention is widely advocated, its impact on postoperative complications and mortality in super‐aged (≥ 80 years) hip fracture patients remains controversial. This study aimed to evaluate the association between early surgery and clinical outcomes in this population.

We conducted a retrospective cohort study of patients aged ≥ 80 years who underwent hip fracture surgery at a single‐center orthopedic trauma center between January 2018 and November 2021. Participants were stratified into early surgery (≤ 48 h post‐admission) and non‐early surgery groups. Propensity score matching (PSM) was employed to control for confounding variables. Primary outcomes included 30‐day, 90‐day, 1‐year, and 2‐year mortality rates. Secondary outcomes encompassed perioperative transfusion rates, postoperative complications, hospital length of stay (LOS), and hospitalization costs.

After PSM, a total of 300 patients were included. Compared with the non‐early surgery group, the early surgery group had lower 1‐year (11.6% vs. 28.0%, p < 0.001) and 2‐year (36.0% vs. 50.7%, p = 0.010) postoperative mortality rates, a lower perioperative blood transfusion rate (32.7% vs. 53.3%, p < 0.001), lower incidences of postoperative pneumonia (15.3% vs. 29.3%, p = 0.004) and delirium (14.0% vs. 36.0%, p < 0.001), a shorter length of stay [8.6 days (7.5, 11.2) vs. 11.6 days (9.7, 14.9), p < 0.001], and lower hospitalization expenses [54,336 ¥ (48,965, 64,532) vs. 61,616 ¥ (50,758, 74,484), p = 0.001]. The serum albumin level at discharge in the early surgery group was higher (33.4 (31.6, 35.4) vs. 32.6 (30.7, 34.9), p = 0.039). Kaplan–Meier survival curve analysis showed that the all‐cause mortality rate in the non‐early surgery group increased (Log Rank p = 0.0066). Multivariate Cox analysis showed that age, BMI, admission hemoglobin, and non‐early surgery were risk factors for 2‐year mortality.

Early surgical intervention for hip fractures in super‐aged patients is associated with improved survival, reduced complications, and better resource utilization. These findings support the implementation of protocols to minimize preoperative delays in this vulnerable population.

Early surgery (< 48 h) in super‐aged hip fracture patients reduces 1–2 years mortality, complications, hospital stay, and costs, supporting timely intervention protocols.