After-Hours Surgery Is Associated With Adverse Perioperative Outcomes Following Hemiarthroplasty for Femoral Neck Fracture.

BACKGROUND: The influence of surgical timing and surgeon subspecialty on outcomes following hemiarthroplasty (HA) for displaced femoral neck fracture (FNF) remains controversial. This study evaluated the impact of admission-to-surgery interval, time of day, and surgeon subspecialty on perioperative outcome and mortality.

METHODS: In this retrospective cohort study, 349 patients undergoing cemented HA for displaced FNF were analyzed. All patients were operated on using the direct anterior approach. Patients were stratified by surgery within 24 hours, operative timing (in-hours versus after-hours versus weekend), and surgeon subspecialty (arthroplasty-trained versus traumatology-trained). Multivariable logistic and linear regression models were used to assess associations with operative times, intra-operative complications, estimated blood losses (EBL), transfusions, periprosthetic joint infections (PJI), deliria, revisions, and 30-day mortalities.

RESULTS: Surgery beyond 24 hours was not independently associated with increased mortality or postoperative morbidity after adjustment. In contrast, after-hours surgery was independently associated with prolonged operative time (+12.3 minutes, P = 0.002), greater EBL (+104 mL, P = 0.003), higher transfusion risk (odds ratio (OR) 2.28, P = 0.015), increased revision risk (OR 3.20, P = 0.015), and higher PJI risk (OR 4.78, P = 0.037). After-hours procedures were also associated with a lower incidence of deliria (OR 0.35, P = 0.036). Surgeon subspecialty was associated with operative duration and transfusion requirements, but not with PJIs, 30-days mortalities, revisions, or deliria.

CONCLUSION: After-hours hemiarthroplasty was independently associated with prolonged operative times, increased blood losses, higher transfusion requirements, and a higher observed risk of PJIs, although the latter finding was based on a small number of events. In contrast, surgery beyond 24 hours from admission and surgeon subspecialty were not independently associated with mortality or major post-operative complications. These findings suggest that the timing of surgery, rather than surgical specialty or moderate delay, may influence perioperative outcomes.