Evidence map›Paper›PMID 41699106›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026

Balancing risks in febrile hip fracture patients: is surgical delay more dangerous than infection?

Snir Balziano, Ili Margalit, Roni Kollender, Dafna Yahav, Alon Freidlander, Dan Prat, Dana Yelin

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Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Snir BalzianoOrthopedic Surgery Department, Sheba Medical Center, Ramat Gan, Israel. SBalaziano@gmail.com.ORCID http://orcid.org/0000-0002-8232-8602
Ili MargalitInfectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
Roni KollenderOrthopedic Surgery Department, Sheba Medical Center, Ramat Gan, Israel.
Dafna YahavInfectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
Alon FreidlanderOrthopedic Surgery Department, Sheba Medical Center, Ramat Gan, Israel.
Dan PratOrthopedic Surgery Department, Sheba Medical Center, Ramat Gan, Israel.
Dana YelinInfectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Fever often delays urgent hip fracture surgery due to infection concerns. This study found that operating early, despite fever, did not increase complications or death compared to waiting. Thus, early surgery appears to be a feasible option for selected patients, avoiding the risks associated with surgical delay. PURPOSE: The optimal timing of hip fracture surgery in patients with preoperative fever remains uncertain. Although early surgery generally improves outcomes, fever often prompts delays because of concerns about underlying infection.

methodsWe retrospectively reviewed 208 patients (median age 83 years, 58% women) with low-energy hip fractures and documented preoperative fever (T > 38 °C) treated at a tertiary trauma center from 2012 to 2023. Patients were categorized by surgical timing: early (≤48 h, n = 108) or delayed (>48 h, n = 100). The primary outcome was one-year all-cause mortality, obtained from the national registry. Secondary outcomes were postoperative length of hospital stay and deep surgical site infection requiring surgical intervention.

resultsOne-year mortality was 20.4% (22/108) in the early group and 31.0% (31/100) in the delayed group (p = 0.079). Median postoperative length of stay was shorter after early surgery (6 days, IQR 4-11) than after delayed surgery (9 days, IQR 5-14; p = 0.031). Deep surgical site infection occurred in 1/108 (0.9%) early patients and 4/100 (4.0%) delayed patients (p = 0.148). Patients selected for early surgery had fewer systemic signs of illness, including lower CRP levels, less desaturation, and less frequent bacterial infections-suggesting that clinical judgment influenced surgical timing. Among patients with confirmed bacterial etiology, early surgery did not increase deep surgical site infection rates or one-year mortality compared to delayed surgery.

conclusionEarly surgery in febrile hip fracture patients may be safe when guided by individualized assessment. Our findings support developing structured clinical criteria to aid surgical timing decisions, warranting further validation through larger prospective studies.

Indexed as

FeverHip FracturesOsteoporotic FracturesTime-to-TreatmentAgedAged, 80 and overFemaleHumansLength of StayMaleProximal Femoral FracturesRetrospective StudiesRisk AssessmentSurgical Wound InfectionTreatment DelayClinical decision-makingFeverGeriatric traumaHip fractureMortalityPatient outcomesPostoperative infectionSurgical delaySurgical site infectionSurgical timing

Identifiers

PMID41699106

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.