“Off-Hour” Surgical Start Times Do Not Influence Surgical Precision and Outcomes in Middle-aged Patients and Patients 65 Years and Older With Hip Fractures

Abstract

Background: Previous studies show the “off-hour” effect impacts outcomes after surgery in non-orthopedic settings. This study assessed if the off-hour effect impacts surgical precision and outcomes in middle-aged patients and patients 65 years and older with hip fractures. Materials and Methods: All operative patients in an academic medical center's institutional review board-approved hip fracture registry were reviewed for demographics, hospital quality measures, operative details, radiographic parameters, and outcomes. Patients were grouped into standard (7 am to 4:59 pm) and off-hour (5 pm to 6:59 am) cohorts depending on surgical start time and comparative analyses were conducted. Two subanalyses were conducted: one comparing the quality of reduction for patients with intertrochanteric hip fractures and another comparing the rates of inpatient transfusion and postoperative dislocation for patients treated with arthroplasty. Results: A total of 2334 patients underwent operative treatment. The off-hour cohort had hospital quality measures and outcomes similar to the standard cohort, including length of stay, rates of inpatient complication, mortality, and readmission. Sub-analysis of 814 intertrochanteric hip fractures demonstrated similar tip-apex distance, residual calcar step-off, and post-fixation neck-shaft angle, while subanalysis of 713 patients undergoing arthroplasty showed similar rates of transfusion and dislocation between cohorts. Conclusion: The time of day patients undergo hip fracture repair does not affect surgical outcomes or hospital quality measures. These results highlight the need for standardized hip protocols and treatment pathways to provide equitable care at all hours of the day. [ Orthopedics . 2024;47(3):185–191.]