Open Access Research article

Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

Julián Librero123, Salvador Peiró13*, Edith Leutscher1, Juan Merlo4, Enrique Bernal-Delgado23, Manuel Ridao123, Natalia Martínez-Lizaga23 and Gabriel Sanfélix-Gimeno13

Author Affiliations

1 Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain

2 Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain

3 Grupo de Variaciones en la Práctica Médica en el Sistema Nacional de Salud

4 Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden

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BMC Health Services Research 2012, 12:15  doi:10.1186/1472-6963-12-15

Published: 18 January 2012



While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.


A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.


Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.


Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.