Surgical Delay in Healthy Elderly Patients with Hip Fractures : How Many Days are Acceptable?

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Chonlathan Iamsumang
Kittipong Diewwattanawiwat


Background: Acceptable waiting time for surgery in elderly patients with hip fractures is still controversial, especially for those who are healthy or have mild systemic diseases (American Society of Anesthesiologists [ASA] physical status class I-II).

Objective: To determine the acceptable waiting time for surgery, without significantly affecting mortality and morbidity risk, in the ASA class I-II elderly patients with hip fractures.

Material and method: A retrospective cohort study was conducted among ASA class I-II patients aged 60 years and above, who had hip fractures within 7 days before undergoing surgeries at Lampang Hospital from January 2007 to December 2017. The total of 799 patients were divided into 11 groups according to the waiting time for surgery of 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and more than 10 days. One-year mortality and 30-day morbidity rate were calculated and compared between groups to find the acceptable waiting time that did not cause significant differences in mortality and morbidity.

Results: The patients had an average age of 75.5±7.9 years (range 60-100). 606 patients were female (75.8 %). The average waiting time to surgery was 5.4±3.0 days (range 0-16). 33 patients (4.1%) died within 1 year after the surgery, and 7 patients (0.9%) had complications within 30 days. The group of patients who waited for surgery >4 days had a 30-day complication rate higher than those who had surgery within 4 days (1.6% vs 0%, p=0.021). The patients who waited for >8 days had a 1-year mortality rate higher than those who had
surgery within 8 days (11.2% vs 3.0%, p=0.001). No significant differences in 1-year mortality rate for the groups of patients who waited for 1, 2, 3, 4, 5, 6 and 7 days (p=1.000, 0.339, 0.449, 0.282, 0.859, 0.240 and 0.050 respectively).

Conclusion: Healthy elderly patients with hip fractures could wait up to 8 days to have surgery from the day of being admitted to the hospital, without significantly increasing the 1-year mortality. However, if the surgery was performed within 4 days, the 30-day complication rate could be reduced.

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How to Cite
Iamsumang, C., & Diewwattanawiwat, K. (2020). Surgical Delay in Healthy Elderly Patients with Hip Fractures : How Many Days are Acceptable?. Lampang Medical Journal, 41(1), 39–48. Retrieved from
Original Article


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