Clinical characteristics of older adults with intertrochanteric hip fracture and factors associated with delayed surgical management at a hospital in Peru
DOI:
https://doi.org/10.58814/01208845.608Keywords:
Intertrochanteric Fractures, Public HealthAbstract
Introduction: Hip fractures in older adults are a public health problem, with intertrochanteric fractures being the most common. Early surgical management (<48 hours) is associated with better clinical outcomes.
Objectives: To describe the clinical characteristics of patients aged ≥60 years with intertrochanteric fractures treated at a tertiary care hospital in Lima (Peru) and to identify factors associated with delayed surgical management (>48 hours after admission).
Methodology: A retrospective cohort study was conducted on 51 patients with intertrochanteric fractures treated in 2023. Sociodemographic and clinical data were obtained by reviewing medical records. “Unavailability for surgical management” was defined as the absence of essential hospital resources to perform surgery due to logistical limitations. A binary logistic regression model was used to explore factors associated with delayed surgical management (<48 hours after admission).
Results: The mean age was 80.23 years, and 64.71% were women. The most common comorbidities were anemia (64.71%) and hypertension (39.22%). Additionally, 23 patients underwent surgical management, with an average time between admission and surgery of 18.30 days; of these, 18 (78.26%) underwent delayed surgical management. The lack of immediate availability for surgical management was associated with receiving delayed surgical management (OR=6.0; 95% CI: 2.0–18.0; p=0.001). The presence of anemia and urinary tract infection suggested exploratory associations with delayed surgical management.
Conclusions: Findings such as the low proportion of surgical management, the high frequency of delayed surgical management, and the prolonged time from admission to surgery highlight the need to implement strategies to optimize hospital resources.
Downloads
References
1. Emmerson BR, Varacallo MA, Inman D. Hip Fracture Overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. PMID: 32491446. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557514/
2. Kokubu Y, Obi A, Kimura Y, Hattori A, Nemoto H, Matsuda Y, Oki Y, Amamiya R, Ogine K, Misawa M, Shimaoka T, Hirose K, Ando Y, Kurashige T, Marusugi K, Kaneyama S, Kawaguchi H. Factors preventing early surgery for hip fractures in elderly patients: The osteoporosis liaison service (OLS)-Kashiwa study. Arch Osteoporos. 2025;20(1):82. https://doi.org/10.1007/s11657-025-01567-8 PMID: 40549107.
3. Davidson A, Giannoudis PV. Failure of Fixation in Trochanteric Hip Fractures: Does Nail Design Matter? J Orthop Trauma. 2023;37(10S):S26-S32. https://doi.org/10.1097/BOT.0000000000002665 PMID: 37710372.
4. Joseph EG, Serotte J, Haider MN, Pavlesen S, Anders M. Delay to Surgical Treatment in Geriatric Hip Fracture Patients. Geriatr Orthop Surg Rehabil. 2023;14:21514593231204760. https://doi.org/10.1177/21514593231204760 PMID: 37867607; PMCID: PMC10588415.
5. Australian Commission on Safety and Quality in Health Care. Hip fracture clinical care standard [Internet]. Sydney: Australian Commission on Safety and Quality in Health Care; 2023 [cited 2026 Jan 19]. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/hip-fracture-clinical-care-standard-2023
6. Tian C, Shi L, Wang J, Zhou J, Rui C, Yin Y, Du W, Chang S, Rui Y. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr. 2025;133:105832. https://doi.org/10.1016/j.archger.2025.105832 PMID: 40112671.
7. Briceño-Arias S, Cristancho-Quevedo YF, Rojas-Herrera CA. Caracterización de fractura intertrocantérica en adultos atendidos en un hospital de tercer/cuarto nivel en Tunja. Ciencia e Innovación en Salud. 2023; e163: 23-21 https://doi.org/10.17081/innosa.163
8. Clark P, Cruz-Priego GA, Rascón-Pacheco RA, Bremer A, Borja-Aburto VH. Incidence of hip fractures in Mexico 2006-2019: increasing numbers but decreasing rates. Osteoporos Int. 2024;35(6):1041-1048. https://doi.org/10.1007/s00198-024-07045-0 PMID: 38459139.
9. Palomino L, Ramírez R, Vejarano J, Ticse R. Fractura de cadera en el adulto mayor: la epidemia ignorada en el Perú. Acta Med Peru. 2016;33(1):15–20. Available from: http://repebis.upch.edu.pe/articulos/acta.med.per/v33n1/a4.pdf
10. Rondón C, Zaga H, Gutiérrez E, Características clínicas y epidemiológicas en adultos mayores con diagnóstico de fractura de cadera en un hospital de Lima, Perú. Acta Med Peru. 2021;38(1):42-7. http://dx.doi.org/10.35663/amp.2021.381.1844
11. Cao Q, Zhang L, Cai X, Shen W, Wu H, Yu A, Xu X. Comparison of clinical characteristics and outcomes among different age groups in elderly patients with hip fracture surgery. PLoS One. 2025;20(10):e0333909. https//doi.org/10.1371/journal.pone.0333909 PMID: 41091715; PMCID: PMC12527124.
12. Dawod MS, Alswerki MN, Ar Altamimi A, Abu Hilal M, Albadaineh A, Saber Y, Alisi MS, Al-Ajlouni J. Comparative analysis of geriatric hip fracture management outcomes in teaching and nonteaching hospitals in Jordan. Sci Rep. 2024;14(1):16053. https//doi.org/10.1038/s41598-024-66016-x PMID: 38992060; PMCID: PMC11239659.
13. Attum B, Pilson H. Intertrochanteric Femur Fracture. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. PMID: 29630213.
14. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;320(20):2191–2194. https://doi.org/10.1001/jama.2013.281053
15. Aguirre-Milachay E, León-Figueroa DA, Valladares-Garrido MJ. Clinical, laboratory, and hospital factors associated with preoperative complications in Peruvian older adults with hip fracture. PLoS One. 2024;19(11):e0313089. https://doi.org/10.1371/journal.pone.0313089 PMID: 39495713; PMCID: PMC11534202.
16. Huamán-Díaz YA, Huamán-Díaz HA. Factores relacionados a la demora del tratamiento quirúrgico de fractura de cadera en adultos mayores de 50 años. Rev Exp Med. 2023;9(3):73-80. https://doi.org/10.37065/rem.v9i3.691
17. Hong G, Zhong H, Illescas A, Reisinger L, Cozowicz C, Poeran J, Liu J, Memtsoudis SG. Trends in hip fracture surgery in the United States from 2016 to 2021: patient characteristics, clinical management, and outcomes. Br J Anaesth. 2024;133(5):955–964. https://doi.org/10.1016/j.bja.2024.07.022. PMID: 39242278.
18. Peng J, Ye P, Zhang J, Zhang X, Peng K, He J, Wen L, Wang X, Shi Z, Hu S, Sun F, Gong Z, Sun M, Liu T, Liu X, Ma R, Zhu S, Wu X, Ivers R, Yang M, Tian M. Characteristics of falls among older hip fracture patients from six Chinese hospitals: a post-hoc descriptive analysis. BMC Geriatr. 2023;23(1):284. https://doi.org/10.1186/s12877-023-03971-6 PMID: 37170210; PMCID: PMC10176772.
19. Chen M, Du Y, Tang W, Yu W, Li H, Zheng S, Cheng Q. Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China. J Bone Miner Metab. 2022;40(6):951-959. https://doi.org/10.1007/s00774-022-01358-y PMID: 35939235.
20. Guan L, Liu Q, Yang J, Wang L, Chen S, Yao Y, et al. Moderate to severe anemia at admission increases the risk of complications in patients over 60 years with hip fracture. BMC Geriatr. 2024;24(775). https://doi.org/10.1186/s12877-024-05335-0
21. George J, Sharma V, Farooque K, Mittal S, Trikha V, Malhotra R. Pre-operative Anemia and Hyponatremia Increase the Risk of Mortality in Elderly Hip Fractures. Arch Bone Jt Surg. 2024;24(1):775. https://doi.org/10.22038/ABJS.2024.76024.3512 PMID: 38817416; PMCID: PMC11134264.
22. Díaz-Domínguez R, González-Chamant E, Llera-Arteaga BR, Reyes-Chirino G, Breijo-Mato LR. Predictors of mortality in older adults with hip fracture. Rehabilitation and Sports Medicine. 2026; 6:216. https://doi.org/10.56294/ri2026216
23. Comodo RM, Di Gialleonardo E, Bocchino G, Capece G, Covino M, Simeoni B, Russo A, Salini S, Maccauro G, Vitiello R. Frailty as a determinant of mortality, surgical timing and hospital stay in proximal femur fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol. 2025;35(1):196. https://doi.org/10.1007/s00590-025-04312-6 PMID: 40369369; PMCID: PMC12078435.
24. Thamviriyarak P. Hip Fracture Surgery Between 24–48 Hours Is a Risk Factor for One-Year Mortality in Elderly Patients. JseaOrtho. 2025;49(2):72-83. https://doi.org/10.56929/jseaortho-2025-0252
25. Welford P, Jones CS, Davies G, Kunutsor SK, Costa ML, Sayers A, Whitehouse MR. The association between surgical fixation of hip fractures within 24 hours and mortality: a systematic review and meta-analysis. Bone Joint J. 2021;103-B(7):1176-86. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2582.R1 PMID: 34192937.
26. Kawakami H, Sasaki H, Kamizono J, Yasutake Y, Fujimoto Y, Taniguchi N. Timely Surgical Intervention for Hip Fractures is Essential to Reinstate Ambulatory Function on Discharge: Propensity Score Matching. JB JS Open Access. 2025 Mar 14;10(1):e24.00037. https://doi.org/10.2106/JBJS.OA.24.00037 PMID: 40094074; PMCID: PMC11896104.
27. Dobre R, Niculescu DA, Cirstoiu C, Popescu G, Poiana C. Mortality rates and risk factors after low-trauma hip fracture in the largest university center in Romania. Arch Osteoporos. 2021;16(1):64. https://doi.org/10.1007/s11657-021-00934-5 PMID: 33834297.
28. Mathur N, Knight J, Betancourt-Garcia M, Pequeno G, Serra-Torres M. Hip Fracture Patterns Among Hispanic Seniors: Risk Factors and Implications. Cureus. 2025;17(3):e80463. https://doi.org/10.7759/cureus.80463 PMID: 40091905; PMCID: PMC11908818.
29. Tan CMP, Park DH, Chen YD, Jagadish MU, Su S, Premchand AXR. Mortality rates for hip fracture patients managed surgically and conservatively in a dedicated unit in Singapore. Arch Orthop Trauma Surg. 2022;142(1):99-104. https//doi.org/10.1007/s00402-020-03605-1 PMID: 32945956.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Author(s).
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
