Does Early Surgery Reduce Mortality Compared With Delayed Surgery Among Patients With Periprosthetic Hip Fracture? A Target Trial Emulation

Using a large Japanese hospital database of 4564 older adults (mean age 84) admitted with a periprosthetic hip fracture, the authors emulated a randomized trial comparing surgery within 2 days of admission with surgery on days 3 to 10, using a clone-censor-weight method to remove immortal time bias. Early surgery did not lower mortality: 30-day risk was 1.72% with early versus 0.83% with delayed surgery (risk difference 0.89%, 95% CI -0.32% to 1.72%), and 90-day risk was essentially identical (2.35% vs 2.31%). The authors conclude that the 48-hour rule for native hip fractures should not be assumed to apply to periprosthetic fractures purely to reduce short-term mortality.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersIt challenges reflexive extension of the 48-hour hip fracture surgery standard to periprosthetic fractures, which often need more complex planning such as revision arthroplasty, and illustrates how immortal time bias can distort timing studies.

Presenting this at rounds? Start here

• ?If early surgery does not clearly reduce 30- or 90-day mortality after periprosthetic hip fracture, how should a team balance medical optimization, imaging, implant procurement, and surgeon availability against the risks of prolonged bed rest such as pressure ulcers, delirium, and pneumonia?
• ?How would you counsel an 85-year-old with a Vancouver B2 fracture and heart failure whose family asks why surgery is not happening within 48 hours, as it would for a native hip fracture?