Time-to-Incision for Hip Fractures in a Canadian Level-1 Trauma Centre: Are We Respecting the Guidelines?


  • Antoine Denis McGill University
  • Julien Montreuil McGill University
  • Rudolf Reindl McGill University
  • Gregory K. Berry McGill University
  • Edward J. Harvey McGill University
  • Mitchell Bernstein McGill University




orthopaedics, traumatology, hip fractures, wait times, geriatric orthopaedics



Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to explore the causes of surgical delays for acute geriatric hip fractures. 


This is a retrospective cohort study involving a total of 109 consecutive geriatric patients who sustained proximal femur fractures (“hip fractures”), who subsequently underwent definitive fixation. Clinical, demographic, and direct costing data were extracted via a modern system and electronic medical records on a centralized data warehouse. Surgical delays and length of stay were analyzed according to clinical variables. 


The established benchmark of a time-to-surgery of less than 48 hours was respected for 63 (57.8%) patients. Patients on oral anticoagulant (ACO) waited significantly longer, on average 58 hours compared to 44 for non-anticoagulated patients (p = .007). Patients with higher ASA scores waited significantly longer (p = .0018). More importantly, patients treated within 48 hours were discharged significantly earlier, on average after 10 days compared to 16 days for patients who waited more than 48 hours before receiving surgical treatment (p = .003), regardless of the pre-operative waiting time. 


Fewer than 60% of patients received surgery within the 48- hour benchmark after being admitted for an acute hip fracture in a Level-1 trauma centre. Patients with more comorbidities waited longer and stayed longer in the hospital after surgery. Implementing strategic, evidence-based changes should be done using this data to improve care of this vulnerable population. 


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How to Cite

Denis A, Montreuil J, Reindl R, Berry GK, Harvey EJ, Bernstein M. Time-to-Incision for Hip Fractures in a Canadian Level-1 Trauma Centre: Are We Respecting the Guidelines?. Can Geriatr J [Internet]. 2022 Mar. 2 [cited 2023 Sep. 27];25(1):57-65. Available from: https://cgjonline.ca/index.php/cgj/article/view/529



Original Research