Factors Affecting Mortality Following Hip Fracture Surgery: Insights from a Long-Term Study at a Level I Trauma Center—Does Timing Matter?

<b>Background/Objectives:</b> The preoperative length of hospital stay (PLHS) is the only major modifiable factor in hip fracture surgery. Identifying the optimal timing for the procedure is crucial for reducing the risk of death. We aimed to explore the association between PLHS and all-cause mortality within six years among adult trauma care patients, as well as to identify independent predictors of mortality. <b>Methods:</b> This retrospective study included all patients ≥ 18 years with primary hip fractures who were admitted to our level I trauma center from 1 January 2015, to 31 December 2018, and who underwent surgery. We subdivided the PLHS into four categories-≤24 h, 24 to 36 h, 36 to 48 h, and >48 h-and performed survival and subgroup analyses. <b>Results:</b> The inclusion criteria yielded 1604 females and 700 males, comprising 1235 intertrochanteric and subtrochanteric fractures and 1069 femoral neck fractures. Performing surgery in any of the first three categories was not independently associated with a reduced risk of mortality within six years compared to surgery delayed for more than 48 h. The independent predictors of mortality were older age, male gender, ASA ≥ 3, CCI ≥ 3, in-hospital complications, and a longer postoperative hospital stay. Patients with intertrochanteric fractures had a significantly higher mortality risk compared to those with femoral neck fractures. <b>Conclusions:</b> The timing of hip fracture surgery is not an independent predictor of mortality. Surgical delay correlates with mortality, but may reflect comorbidity-related selection rather than a direct causal effect.