Impact of Increased Time-to-Surgery on Outcomes in Geriatric Acetabular Fracture Patients

Introduction: Studies have demonstrated that increased time-to-surgery (TTS) for geriatric femoral neck fracture (FNF) patients is correlated with negative outcomes. Data is limited on the impact of expedited care among geriatric acetabular fracture patients. In this study, we explore the association between TTS and postoperative complication in patients with geriatric acetabular fractures. Methods: Among 51 patients ≥60 years, presenting at a level-I trauma center (2013-2020) TTS was calculated as the time from admission to surgery (hours). The threshold for delayed TTS was selected as >48 hours. Logistic regression analyses were preformed (odds ratios (OR), 95% confidence interval (CI)) to evaluate the impact of TTS on in-hospital complication and length of hospital stay (LOS). Frailty, the primary covariate, was calculated using a previously validated 11-point modified frailty index (mFI). Results: Of the 51 patients, 19 (37.3%) had at least one in-hospital complication; most commonly: acute blood loss anemia requiring transfusion and delirium. Patients with delayed TTS had 5x higher odds of developing at least one in-hospitalcomplication (OR:4.86, CI:1.48-15.96). Patients with delayed TTS had a longer LOS (19±14 days vs 12±7 days)(p = 0.040). Frailty (mFI-11≥0.27) was not associated with delayed TTS (r=0.11, p = 0.453) or postoperative complication (r=0.28, p = 0.05). There were no 30-day mortalities in either group. Conclusion: Irrespective of frailty, geriatric acetabular fracture patients with a TTS >48 hours had increased postoperative complication and LOS. These data suggests that expedited care does portend a similar protective effect in geriatric acetabular fracture patients as it does for FNF patients.