Surgery within Two Days of Admission Reduces Complications and Mortality of Patients with Trochanteric Femur Fractures: A Japanese DPC Study

An early surgery for older adult patients with hip fractures is recommended to avoid perioperative complications in existing clinical guidelines. Few studies have analyzed only transtrochanteric fractures. The purpose of this study was to assess whether surgery within two days of admission reduces the incidence of pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization in patients with older adult transtrochanteric femur fractures. In this retrospective study, we used the Japanese National Administrative DPC (Diagnosis Procedure Combination) database that covers April 2016 to March 2022. Transtrochanteric femur fracture was included in patients aged 65 years or older who underwent surgery. The perioperative complications with pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, and mortality during hospitalization were assessed after propensity score matching, focusing on surgeries conducted within two days of admission. After one-to-one propensity score matching for age, sex, and comorbidity, we identified 79,649 pairs of patients who underwent surgery either within two days or after the third day of admission. Surgery delayed beyond two days was independently associated with increased pneumonia, pulmonary embolism, pressure ulcers, and mortality during hospitalization with risk ratios of 1.335 (95% CI: 1.256-1.418, p < 0.0001), 1.287 (95% CI: 1.225-1.351, p < 0.0001), 1.229 (95% CI: 1.094-1.380, p < 0.0001), and 1.063 (95% CI: 0.978-1.155, p = 0.0035), respectively. Surgery within two days of admission for transtrochanteric femur fracture effectively prevents perioperative complications and reduces mortality during hospitalization.