Original Article

European Journal of Trauma and Emergency Surgery

, Volume 33, Issue 3, pp 238-244

Open Access This content is freely available online to anyone, anywhere at any time.

Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery

  • Leonard M. F. RademakersAffiliated withDepartment of Cardiothoracic Surgery, Maastricht University HospitalDepartment of Cardiothoracic Surgery, Maastricht University Hospital Email author 
  • , Tryfon VainasAffiliated withDepartment of Surgery, Maastricht University Hospital
  • , Stefan W. A. M. van ZutphenAffiliated withDepartment of Surgery, TweeSteden Hospital
  • , Peter R. G. BrinkAffiliated withDepartment of Traumatology, Maastricht University Hospital
  • , Sven H. van HeldenAffiliated withDepartment of Traumatology, Maastricht University Hospital



Hip fractures are associated with high morbidity. Pressure ulcer formation after hip surgery is often related to delayed patient mobilization. The objectives of this study were to determine whether time-to-surgery affects development of pressure ulcers postoperatively and, thus, length of hospital stay.

Patients and Methods:

We performed a retrospective analysis of consecutive hip fracture patients, aged 60 years and above, who underwent surgery between 1995 and 2001. The primary outcome was in-hospital development of pressure ulcers. The secondary outcome measure was the overall length of hospital stay. Analyses were adjusted for relevant confounders.


Of the 722 patients enrolled, 488 patients (68%) received surgery at 12 h after admission. Approximately 30% (n = 214) developed pressure ulcers during admission, whilst 19% of patients operated within 12 h of admission developed pressure ulcers. Time-to-surgery was an independent predictor of both development of pressure ulcers (OR = 1.7, 95% confidence interval [CI] = 1.2–2.6; p = 0.008) and length of hospital stay (11.3 vs 13.3 days in the early and the late surgery group, respectively, p = 0.050). Furthermore, development of pressure ulcers was associated with prolonged postoperative hospital stay (19.5 vs 11.1 days for patients with and without pressure ulcers, respectively, p = 0.001)


In hip fracture patients, time-to-surgery was an independent predictor of both postoperative pressure ulcer development and prolonged hospital stay. These data suggest that the implementation of an early surgery protocol following admission for hip fractures may reduce both the postoperative complications and overall hospital stay.

Key Words

Soft tissue injuries and infection Fracture care Hip fracture Fractures of the proximal Femur Hip fractures Orthopedic trauma Osteosynthesis