Waiting for theatre space beyond 36 hours was linked to higher hip fracture mortality

Design

Single-centre retrospective cohort with propensity-score matching

Population

2,358 patients aged ≥65 with operatively managed hip fracture; medical delays excluded

Primary outcome

Mortality at 30 and 365 days

Effect

365-day HR 1.37 (95% CI 1.15–1.63); 30-day HR 1.71 (1.11–2.65); frail patients 30-day OR 1.76 (1.06–3.02)

Earlier studies of timing in hip fracture could not separate delays for lack of theatre time from delays because the patient was too unwell to operate on, and the second kind inflates the apparent harm. This UK teaching-hospital cohort of patients aged 65 or over, treated between 2020 and 2024, excluded medical delays entirely and compared those operated on within 36 hours with those who waited longer only because of capacity.

Of 2,358 eligible patients, 54% had a capacity delay. After propensity matching (median age 85, 73% women), capacity delay was associated with higher one-year mortality (HR 1.37, 95% CI 1.15–1.63), and the association was strongest in the first 30 days (HR 1.71, 1.11–2.65). The 30-day effect was concentrated in patients with a Clinical Frailty Scale score above 4; in fitter patients it was not significant.

This is a single-centre observational study, so unmeasured factors could still play a part, and the population was almost entirely White. But the design removes the most important confounder, and the frailty gradient is clinically plausible. For Indian units, where theatre access is often the binding constraint, it argues for putting the frailest patients first on the list rather than taking cases in order of arrival. It was published in September 2026.

• Put frail hip fracture patients (Clinical Frailty Scale above 4) first when theatre capacity is limited.
• Aim for surgery within 36 hours of arrival for all patients who are medically fit.
• Record the reason for every delay, separating capacity from medical causes, so it can be audited.
• Escalate recurrent capacity delays to management with your own mortality data.
• Do not rush surgery in a patient who genuinely needs medical optimisation; this study excluded them.

Why it matters

It isolates the harm that hospitals, not patients, cause by making them wait.

Don't overread it

It is one hospital's observational data; it cannot prove that shorter waits alone would prevent these deaths.

The statistics, in plain English

A hazard ratio of 1.37 means the death rate over a year was about 37% higher among those who waited, after matching on factors that affect survival. The 30-day interval (1.11–2.65) is wide, so the early effect is less precise. Propensity matching balances measured factors but not unmeasured ones.

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