International Orthopaedics

, Volume 42, Issue 8, pp 1789–1794 | Cite as

Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing

  • Siu Him Janus Wong
  • Xinshuo Christian FangEmail author
  • King Hang Dennis Yee
  • Tak Man Wong
  • Cheuk Ting Terence Pun
  • Tak Wing Lau
  • Ka Li Frankie Leung
Original Paper



The association between delayed hip fracture surgery and mortality remains elusive because of strong confounding by comorbidity factors. We designed a study to investigate the effect of small delays in surgery due to holidays.


Consecutive hip fractures operated in a high-income, publicly funded healthcare system between 2006 and 2013 were analysed. Age <65 years, pathological fractures, history of previous hip operation and time to surgery >seven days were excluded. Patients were grouped according to number of holidays following admission (HFA) as a surrogate for time to surgery, with difference in mean time to surgery tested for statistical significance and baseline characteristics including age, sex, Charlson comorbidity index (CCI) and fracture and operation types assessed. Survival up to two years was compared.


Thirty-one thousand five hundred and ninety-two patients were included. Patient groups with zero, one, two or three HFA had significantly different mean time to operation of 2.25, 2.47, 2.67 and 2.84 days, respectively (Kruskal–Wallis test p < 0.0001), but baseline characteristics were similar. There was no difference in mortality at six months (p = 0.431) and two years (p = 0.785). Cox’s regression analysis identified age, gender and CCI as independent predictors of mortality but not HFA, and the adjusted hazards ratio for each HFA increment was 1.026 [95% confidence interval (CI) 0.999–1.025; p = 0.056] which was not statistically significant.


We observed no increase in mortality rate in patients having small delays in surgery because of holidays.


Hip fracture Mortality Time to surgery Surgical timing 



The authors would like to thank the Divisions of Orthopaedic Trauma and General Orthopaedics & Oncology at Queen Mary Hospital Department of Orthopaedics & Traumatology, Hospital Authority Clinical Data Analysis and Reporting System and Clinical Co-ordinating Committee in Orthopaedics & Traumatology for their support.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Siu Him Janus Wong
    • 1
  • Xinshuo Christian Fang
    • 2
    • 3
    Email author
  • King Hang Dennis Yee
    • 1
  • Tak Man Wong
    • 2
    • 3
  • Cheuk Ting Terence Pun
    • 2
  • Tak Wing Lau
    • 1
  • Ka Li Frankie Leung
    • 2
    • 3
  1. 1.Department of Orthopaedics & TraumatologyQueen Mary HospitalHong KongChina
  2. 2.Department of Orthopaedics & TraumatologyUniversity of Hong KongHong KongChina
  3. 3.Shenzhen Key Laboratory for Innovative Technology in Orthopaedic TraumaThe University of Hong Kong-Shenzhen HospitalShenzhenChina

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