Early hip arthroplasty in elderly hip-fracture patients: a perspective from HbA1c

To investigate whether stress-induced hyperglycemia influences postoperative outcomes in hip fracture patients with normal hemoglobin A1c (HbA1c) levels, and to determine if delaying surgery for blood glucose normalization is necessary. This multicentre retrospective cohort (August 2017 – November 2022) included 212 patients (≥ 60 years) with femoral-neck or intertrochanteric fractures and admission random glucose ≥ 11.1 mmol/L. Patients were classified as early surgery (< 24 h from admission; median 18 h) or delayed surgery (≥ 24 h; median 38 h) after fasting glucose was reduced to 7.0–8.0 mmol/L. Primary outcomes were postoperative infection and delayed wound healing (failure to heal within 14 days). Secondary outcomes were Harris Hip Score (HHS) at 12 months and 24-h Visual Analogue Scale (VAS) pain. Multivariable logistic and linear regression adjusted for age, gender, body mass index (BMI), diabetes, hypertension, operative time, American Society of Anesthesiologists (ASA) classification and surgery type. Early surgery was not associated with higher infection risk (adjusted odds ratio [aOR] = 1.22, 95% CI 0.91–1.64) or delayed wound healing (aOR = 0.99, 95% CI 0.23–4.31). It had no significant impact on hip function (β = − 1.05, 95% CI − 1.99 to 0.12) or VAS pain (β = − 0.08, 95% CI − 0.42 to 0.27). BMI independently predicted outcomes: each 1 kg/m² increase raised infection risk by 16% (aOR = 1.16, 95% CI 1.07–1.26) but lowered the likelihood of delayed healing (aOR = 0.75, 95% CI 0.62–0.91). In hip fracture patients with stress-induced hyperglycemia but normal HbA1c levels, delaying surgery for blood glucose normalization does not significantly impact postoperative outcomes. Therefore, surgery should not be postponed solely due to elevated blood glucose levels. Emphasizing the long-term optimization of nutritional status and weight maintenance may reduce postoperative infections and improve functional recovery.