¹MUM – Muskuloskelettales Universitätszentrum München am LMU Klinikum, Munich, Deutschland

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Objectives and questions: Medial femoral neck fractures are the most common fractures in the elderly population in Germany and pose a significant clinical challenge. The “Gemeinsamer Bundes-Ausschuss” (G-BA) mandates surgical treatment within 24 hours of hospital admission to reduce complications. However, it remains unclear whether strict adherence to this time requirement provides better outcomes than optimizing surgical conditions, such as surgeon expertise and procedural timing.

This study aims to: Assess the impact of surgical timing by determining whether surgeries performed outside regular operating hours are associated with increased complication rates and mortality.

Examine the role of surgical expertise and volume in influencing patient outcomes.

Evaluate a “Best Team, Best Time” approach by analyzing its effect on clinical outcomes.

Material and methods: This retrospective study includes 351 patients who underwent cemented arthroplasty for a medial femoral neck fracture. Patients were identified through the hospital’s patient documentation system. The following parameters were recorded: time of injury, admission time, time to surgery, surgery duration, composition of the surgical team, blood loss, perioperative complications, and mortality.

Results: A total of 303 patients underwent surgery within 24 hours. The revision rate was 8.9% for surgeries performed within 24 hours compared to 6.3% for those beyond 24 hours (p = 0.78). Periprosthetic infections were observed in 3.0% (<24 h) and 8.3% (>24 h) of cases (p = 0.08).

Revision rates varied based on surgical timing, with rates of 6.3% during regular working hours, 7.8% on weekends, and 17.2% during on-call nighttime duty (p = 0.03).

Surgery duration was significantly prolonged on weekends (+13.3 min) and during on-call duty (+15 min). Non-specialist surgeons performed 80% of procedures, while high volume arthroplasty surgeons were involved in 20%. The absence of a specialist was associated with higher revision rates (7.4% vs. 1.1%), infections (3.1% vs. 0.6%), and greater transfusion requirements (27% vs. 2.2%),

Discussion and conclusions: Adherence to the 24-hour surgery requirement had no significant impact on revision rates or 30-day mortality. However, surgeries performed outside regular hours were associated with a higher revision rates and longer operative times. Surgical expertise emerged as a critical factor: with specialist involvement significantly improving outcomes by reducing revision rates, infections, and transfusion requirements. This study suggests that a "Best Team, Best Time" approach may enhance clinical outcomes and should be considered in future treatment strategies to optimize patient care.