Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.