In-Hospital Proximal Femoral Fracture Mortality and Anesthesia: Do the First Postoperative 72 h Matter?

<b>Background/Objectives</b>: Proximal femoral fractures (PFFs) are a common worldwide ailment, causing high morbidity and mortality among the elderly, with one-year mortality estimated at 15-30%. This study aimed to identify factors influencing in-hospital patient survival after proximal femoral fracture surgery. <b>Methods</b>: A retrospective cohort study of patients over 65 admitted to an orthopedic surgery department due to a PFF over five years was carried out. Medical records, surgery reports, anesthesia and post-anesthesia care unit sheets, and laboratory archives were reviewed. <b>Results</b>: The study group consisted of 48 patients who died during the first postoperative week, while the control group consisted of 69 patients who were discharged for rehabilitation after a week. The study group was older, less active, and had higher rates of comorbidities. Anesthetic factors, such as the type of anesthesia and admixture of drugs, did not have a significant association with mortality. However, a binary logistic regression showed that age (OR = 1.15, <i>p</i> < 0.001), intraoperative lactate levels (OR = 5.86, <i>p</i> < 0.001), and post-anesthesia care unit (PACU) overnight stays (OR = 17.54, <i>p</i> < 0.001) were significantly associated with early mortality. <b>Conclusions</b>: The study highlights the challenge of identifying PFF patients at risk of early mortality and the need to better understand the decision-making algorithm to create a reliable scale that can predict mortality and adjust treatment. In our study, solid mortality parameters were age and intraoperative lactate levels. The most significant parameter was PACU overnight stay, which represents the anesthesiologist's soft-skill-based decision that is challenging to scale and reproduce.