Preoperative stay under 48 h after admission for proximal femur fractures is linked to fewer complications and better outcomes.

PURPOSE: To evaluate the association between admission-to-surgery time (with a focus on < 48 h) and postoperative complications and discharge mobility in patients with proximal femur fractures (PFFs), using a large administrative dataset from routine inpatient care in Germany. METHODS: In this retrospective database analysis, 128,092 patient records from external inpatient quality assurance (North Rhine-Westphalia, Germany, 2016-2020) were included. All patients underwent surgical treatment for PFFs and were stratified by time to surgery as early surgery (Group A; within 48 h of admission) or delayed surgery (Group B; more than 48 h after admission). Two cohorts were analysed separately: hip arthroplasty (HA: early 57,635; delayed 7,504) and osteosynthesis (OST: early 59,466; delayed 3,487). Associations between admission-to-surgery time, postoperative complications, pre-admission anticoagulant therapy and inability to walk at discharge were assessed using descriptive statistics and binary logistic regression. Patients unable to walk before the fracture were excluded from the mobility analysis. Reporting was guided by the STROBE statement. RESULTS: In-hospital mortality was 4.7% after early versus 9.7% after delayed surgery (OST) and 5.8% versus 9.3% (HA). Delayed surgery was associated with higher odds of postoperative complications (OST: OR 1.21, 95% CI 1.11-1.34; HA: OR 1.30, 95% CI 1.22-1.39) and higher odds of immobility at discharge (OST: OR 1.38, 95% CI 1.27-1.50; HA: OR 1.34, 95% CI 1.26-1.43); all p < 0.001. Pre-admission anticoagulation was associated with higher complication risk (OST: OR 1.21, 95% CI 1.15-1.27; HA: OR 1.20, 95% CI 1.15-1.26; both p < 0.001). Delayed-surgery patients had a heavier comorbidity and anticoagulation burden and higher care levels than early-surgery patients. CONCLUSIONS: Admission-to-surgery time under 48 h was associated with fewer complications and better discharge mobility in both treatment cohorts. These findings are consistent with, rather than establishing, a benefit of minimising admission-to-surgery time: because delayed-surgery patients were a higher-risk group, the associations may partly reflect confounding by indication. Early postoperative mobilisation should be prioritised alongside timely surgery.