JOA - 2026-09-12 - Journal Article
After-Hours Surgery Is Associated With Adverse Perioperative Outcomes Following Hemiarthroplasty for Femoral Neck Fracture.
Beckers G, Deuschle J, Böcker W, Holzapfel BM, Simon D, Lerchenberger M
Topics
Key Takeaway
After-hours hemiarthroplasty for femoral neck fracture carries a 4.78-fold increased PJI risk and 3.20-fold increased revision risk compared to in-hours cases, independent of admission-to-surgery interval or surgeon subspecialty.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective cohort examined whether admission-to-surgery interval, operative timing (in-hours vs. after-hours vs. weekend), and surgeon subspecialty (arthroplasty vs. trauma) independently predicted perioperative outcomes in 349 patients undergoing cemented DAA hemiarthroplasty for displaced femoral neck fracture. After-hours surgery was independently associated with +12.3 minutes operative time, +104 mL EBL, OR 2.28 for transfusion, OR 3.20 for revision, and OR 4.78 for PJI on multivariable analysis. Surgery beyond 24 hours from admission and surgeon subspecialty were not independently associated with mortality or major morbidity.
Key Limitation
The PJI and revision analyses are event-limited with undefined follow-up duration, making the OR 4.78 PJI association statistically fragile and potentially confounded by differential postoperative surveillance between timing cohorts.
Original Abstract
BACKGROUND
The influence of surgical timing and surgeon subspecialty on outcomes following hemiarthroplasty (HA) for displaced femoral neck fracture (FNF) remains controversial. This study evaluated the impact of admission-to-surgery interval, time of day, and surgeon subspecialty on perioperative outcome and mortality.
METHODS
In this retrospective cohort study, 349 patients undergoing cemented HA for displaced FNF were analyzed. All patients were operated on using the direct anterior approach. Patients were stratified by surgery within 24 hours, operative timing (in-hours versus after-hours versus weekend), and surgeon subspecialty (arthroplasty-trained versus traumatology-trained). Multivariable logistic and linear regression models were used to assess associations with operative times, intra-operative complications, estimated blood losses (EBL), transfusions, periprosthetic joint infections (PJI), deliria, revisions, and 30-day mortalities.
RESULTS
Surgery beyond 24 hours was not independently associated with increased mortality or postoperative morbidity after adjustment. In contrast, after-hours surgery was independently associated with prolonged operative time (+12.3 minutes, P = 0.002), greater EBL (+104 mL, P = 0.003), higher transfusion risk (odds ratio (OR) 2.28, P = 0.015), increased revision risk (OR 3.20, P = 0.015), and higher PJI risk (OR 4.78, P = 0.037). After-hours procedures were also associated with a lower incidence of deliria (OR 0.35, P = 0.036). Surgeon subspecialty was associated with operative duration and transfusion requirements, but not with PJIs, 30-days mortalities, revisions, or deliria.
CONCLUSION
After-hours hemiarthroplasty was independently associated with prolonged operative times, increased blood losses, higher transfusion requirements, and a higher observed risk of PJIs, although the latter finding was based on a small number of events. In contrast, surgery beyond 24 hours from admission and surgeon subspecialty were not independently associated with mortality or major post-operative complications. These findings suggest that the timing of surgery, rather than surgical specialty or moderate delay, may influence perioperative outcomes.