Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures

Yu Jiang; Shuhuai Tan; Kaihua Qin; Sizheng Zhao; Tianjunke Zhou; Dingfa Liang; Tingjie Zhao; Wen Ju; Zhi Wen; Hui Guo; Yong Xie; Xiang Cui; Peifu  Tang; Houchen  Lyu; Licheng   Zhang

doi:10.1016/j.injury.2025.112727

Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures

Yu Jiang, Shuhuai Tan, Kaihua Qin, Sizheng Zhao, Tianjunke Zhou, Dingfa Liang, Tingjie Zhao, Wen Ju, Zhi Wen, Hui Guo, Yong Xie, Xiang Cui, Peifu Tang^*, Houchen Lyu, Licheng Zhang

^*Corresponding author for this work

Division of Musculoskeletal & Dermatological Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose
Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery.

Methods
We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes.

Results
Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12–1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person–years; adjusted hazard ratio = 1.25, 95 % CI, 1.01–1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay.

Conclusion
Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.

Original language	English
Article number	112727
Journal	Injury
Volume	56
Issue number	11
Early online date	25 Aug 2025
DOIs	https://doi.org/10.1016/j.injury.2025.112727
Publication status	E-pub ahead of print - 25 Aug 2025

Keywords

hip-fracture
mortality
postoperative complications
prehospital delay
risk factor

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10.1016/j.injury.2025.112727

Injury manuscript finalAccepted author manuscript, 2.13 MBLicence: CC BY

https://linkinghub.elsevier.com/retrieve/pii/S0020138325005856

NIHR Manchester Biomedical Research Centre
Bruce, I. (PI), Lord, G. (CoI), Lennon, R. (CoI), Black, G. (CoI), Wedge, D. (CoI), Morris, A. (CoI), Hussell, T. (CoI), Sharrocks, A. (CoI), Stivaros, S. (CoI), Buch, M. (CoI), Gough, J. (CoI), Kostarelos, K. (CoI), Thistlethwaite, F. (CoI), Kadler, K. (CoI), Barton, A. (CoI), Hyrich, K. (CoI), Mcbeth, J. (CoI), O'Neill, T. (CoI), Vestbo, J. (CoI), Simpson, A. (CoI), Singh, S. (CoI), Smith, J. (CoI), Felton, T. (CoI), Murray, C. (CoI), Griffiths, C. (CoI), Cullum, N. (CoI), Rhodes, L. (CoI), Warren, R. (CoI), Paus, R. (CoI), Dumville, J. (CoI), Viros Usandizaga, A. (CoI), Keavney, B. (CoI), Tomaszewski, M. (CoI), Allan, S. (CoI), Body, R. (CoI), Cartwright, E. (CoI), Heagerty, A. (CoI), Kalra, P. (CoI), Miller, C. (CoI), Rutter, M. (CoI), Smith, C. (CoI), Trafford, A. (CoI), Evans, D. (CoI), Crosbie, E. (CoI), Crosbie, P. (CoI), Harvie, M. (CoI), Howell, S. (CoI), Renehan, A. (CoI), Dive, C. (CoI), Blackhall, F. (CoI), Landers, D. (CoI), Krebs, M. (CoI), Cook, N. (CoI), Clarke, R. (CoI), Taylor, S. (CoI), Jorgensen, C. (CoI), Lorigan, P. (CoI), Jayson, G. (CoI), Valle, J. (CoI), Mccabe, M. (CoI), Armstrong, A. (CoI), Freitas, A. (CoI), Illidge, T. (CoI), Choudhury, A. (CoI), Hoskin, P. (CoI), West, C. (CoI), Van Herk, M. (CoI), Faivre-Finn, C. (CoI), Bristow, R. (CoI), Kirkby, K. (CoI), Birtle, A. (CoI), Mackay, R. (CoI), Radford, J. (CoI), Linton, K. (CoI), Higham, C. (CoI), Munro, K. (CoI), Plack, C. (CoI), Arden Armitage, C. (CoI), Bruce, I. (CoI), Moore, D. (CoI), Saunders, G. (CoI), Stone, M. (CoI), Haddock, G. (CoI), Lewis, S. (CoI), Elliott, R. (CoI), Green, J. (CoI), Lovell, K. (CoI), Morrison, A. (CoI), Shaw, J. (CoI), Bucci, S. (CoI), Ainsworth, J. (CoI), Webb, R. (CoI), Newman, W. (CoI), Banka, S. (CoI), Clayton-Smith, J. (CoI), Payne, K. (CoI), Moldovan, R. (CoI), Wynn, R. (CoI) & Jones, S. (CoI)
1/12/22 → 30/11/27
Project: Research
Centre for Epidemiology Versus Arthritis.
Dixon, W. (PI), Bruce, I. (CoI), Felson, D. (CoI), Hyrich, K. (CoI), Lunt, M. (CoI), Mcbeth, J. (CoI), Mcdonagh, J. (CoI), O'Neill, T. (CoI), Sergeant, J. (CoI), Verstappen, S. (CoI) & Serafimova, I. (Support team)
1/08/18 → 31/01/26
Project: Research

Cite this

Jiang, Y., Tan, S., Qin, K., Zhao, S., Zhou, T., Liang, D., Zhao, T., Ju, W., Wen, Z., Guo, H., Xie, Y., Cui, X., Tang, P., Lyu, H., & Zhang, L. (2025). Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures. Injury, 56(11), Article 112727. Advance online publication. https://doi.org/10.1016/j.injury.2025.112727

@article{6221be64a2d24494805bc9138b1ccefb,

title = "Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures",

abstract = "Purpose Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery. Methods We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes. Results Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 \% female), 1152 (37.1 \%) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 \% vs. 16.8 \%; adjusted odds ratio = 1.41, 95 \% CI, 1.12–1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person–years; adjusted hazard ratio = 1.25, 95 \% CI, 1.01–1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay. Conclusion Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.",

keywords = "hip-fracture, mortality, postoperative complications, prehospital delay, risk factor",

author = "Yu Jiang and Shuhuai Tan and Kaihua Qin and Sizheng Zhao and Tianjunke Zhou and Dingfa Liang and Tingjie Zhao and Wen Ju and Zhi Wen and Hui Guo and Yong Xie and Xiang Cui and Peifu Tang and Houchen Lyu and Licheng Zhang",

year = "2025",

month = aug,

day = "25",

doi = "10.1016/j.injury.2025.112727",

language = "English",

volume = "56",

journal = "Injury",

issn = "0020-1383",

publisher = "Elsevier BV",

number = "11",

}

TY - JOUR

T1 - Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures

AU - Jiang, Yu

AU - Tan, Shuhuai

AU - Qin, Kaihua

AU - Zhao, Sizheng

AU - Zhou, Tianjunke

AU - Liang, Dingfa

AU - Zhao, Tingjie

AU - Ju, Wen

AU - Wen, Zhi

AU - Guo, Hui

AU - Xie, Yong

AU - Cui, Xiang

AU - Tang, Peifu

AU - Lyu, Houchen

AU - Zhang, Licheng

PY - 2025/8/25

Y1 - 2025/8/25

N2 - Purpose Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery. Methods We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes. Results Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12–1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person–years; adjusted hazard ratio = 1.25, 95 % CI, 1.01–1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay. Conclusion Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.

AB - Purpose Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery. Methods We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes. Results Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12–1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person–years; adjusted hazard ratio = 1.25, 95 % CI, 1.01–1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay. Conclusion Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.

KW - hip-fracture

KW - mortality

KW - postoperative complications

KW - prehospital delay

KW - risk factor

U2 - 10.1016/j.injury.2025.112727

DO - 10.1016/j.injury.2025.112727

M3 - Article

SN - 0020-1383

VL - 56

JO - Injury

JF - Injury

IS - 11

M1 - 112727

ER -

Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures

Abstract

Keywords

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Projects

NIHR Manchester Biomedical Research Centre

Centre for Epidemiology Versus Arthritis.

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