Xin Xu,1,2 Hui Yu,1,2 Junxiang Wang,1,2 Junfei Guo1 

1Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Xi’an Key Laboratory of Pathogenesis and Precision Treatment of Arthritis, Xi’an, Shaanxi, People’s Republic of China

Correspondence: Junfei Guo, Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, No. 555, Youyi East Road, Beilin District, Xi’an, Shaanxi, 710054, People’s Republic of China, Email drjfguo@163.com

Abstract: The optimal timing for hip fracture surgery in elderly patients remains a topic of intense debate and complexity, with many factors influencing the decision-making process. This review examines the current evidence, exploring the advantages and challenges of early versus delayed intervention. It considers medical stability, preoperative medical stabilization, and patient comorbidities, and logistical challenges such as operating room availability and specialized physician access. While multiple studies have examined early versus delayed surgery, a universally agreed definition of “unacceptable delay” is absent. Some evidence indicates that postponing surgery beyond 24 hours may not significantly impact mortality and complication rates, especially in individuals with complex medical conditions. Conversely, early intervention within 48 hours is often recommended for stable patients. Several contributing factors, such as preoperative medical stabilization, hospital resources, and organizational structures, further complicate the issue. This review highlights the need for a nuanced, individualized, and patient-centered approach, taking into account the unique needs of each patient and the specific circumstances of the healthcare setting. It also emphasizes the importance of further research to provide a more comprehensive understanding of what constitutes an optimal delay, rather than adhering to rigid time frames. By offering a multifaceted examination of this critical subject, the review contributes valuable insights that may guide future clinical practice and policy in orthopedic care.

Keywords: hip fracture, elderly, surgical timing, early surgery, delayed surgery, narrative review