In-hospital outcome after trochanteric femur fractures is related to preoperative delay but not to the time of day of the procedure: a nationwide retrospective cohort study of 7184 patients.

Introduction
Hip fractures are a growing public health concern, and efficient management is critical. Surgical timing is a key modifiable factor influencing outcomes, but fracture-specific data - particularly for trochanteric fractures - remains limited. Moreover, concerns regarding the safety of nighttime surgery may contribute to procedural delays.Aim
This study investigates how time to surgery and timing of surgery (day vs. night) affect in-hospital complication and mortality rates in patients undergoing trochanteric fracture fixation.Materials And Methods
This nationwide registry study included 7,184 patients who underwent closed reduction and internal fixation for a trochanteric femur fracture. Patient demographics, surgical details, hospitalization characteristics, and discharge data were analyzed. Patients were stratified by preoperative interval (< 24 vs. >24 h) and surgery starting time (day vs. night). The primary outcome was in-hospital complications; secondary outcome was in-hospital mortality. Unpaired t-tests, chi-square tests, and backward stepwise binary logistic regression were performed (p < 0.05 considered significant).Results
Patients were predominantly elderly, chronically ill women with statutory insurance. The overall in-hospital complication rate was 17%, and the mortality rate was 3.4%. Surgery delayed beyond 24 h was associated with higher complication rates, longer operative times and hospital stays, and lower discharge mobility. Delay was an independent risk factor for complications and was associated with increased mortality, though not independently. No significant differences were observed between day and night surgeries.Discussion
Our fracture-specific findings align with current clinical guidelines: surgery within 24 h leads to better in-hospital outcomes. Delays were linked to a 38% rise in complications and a 74% increase in mortality. Nighttime surgery was demonstrated to be safe and should not be avoided without medical justification. The study's limitations include its retrospective design and its focus on in-hospital outcomes only.Conclusion
Minimizing surgical delay for trochanteric fractures is fundamental. System-level improvements and interdisciplinary coordination are needed to ensure timely care. Given the aging population, the implementation of streamlined treatment pathways is increasingly important.