Early Surgical Management of Periprosthetic Hip Fracture Does Not Reduce Mortality or Cardiopulmonary Complications: A Propensity-Matched Analysis.

Background

Whether early surgery reduces mortality in revision total hip arthroplasty (THA) for periprosthetic proximal femur fractures (PPFF) remains unclear. The aim of this study was to evaluate the association between time to surgery and short- and long-term outcomes following PPFF.

Methods

Using a large national database, adult patients undergoing revision THA for PPFF were identified. Cohorts were defined by time from diagnosis to surgery: two days versus greater than two days. Propensity score matching (1:1) was performed on demographics and comorbidities, yielding 2,098 patients per cohort. The primary outcome was mortality at 30 days, 90 days, and one year. The secondary outcomes included myocardial infarction (MI), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia (PNA), acute kidney injury (AKI), sepsis, surgical site infection (SSI), wound dehiscence, and transfusion.

Results

The 30-day mortality did not differ between early and delayed cohorts (2.4 versus 2.5%, P = 0.842). Similarly, 90-day mortality (4.8 versus 4.4%) and 1-year mortality (7.7 versus 7.9%) were equivocal. Rates of MI, DVT, PE, PNA, AKI, sepsis, SSI, and wound dehiscence were not significantly different across time windows. However, early surgery was associated with significantly higher transfusion rates at 30 (19.7 versus 16.4%, P = 0.006) and 90 days (19.9 versus 17.5%, P = 0.045).

Conclusion

Early operative intervention (two days) for PPFF does not significantly reduce mortality or cardiopulmonary complications compared with delayed surgery (greater than two days). In contrast, early surgery was associated with higher rates of blood transfusion; however, this difference may not be clinically meaningful and should not be interpreted as a reason for unnecessary surgical delay. These findings indicate that delay to surgery beyond two days does not appear to adversely affect short-term mortality or complication rates, allowing additional time for preoperative planning and appropriate allocation of specialized resources.