The researchers found one other factor that affects the risk of complications: how fast a hip fracture patient gets treated. Those who get surgery – either to put the bones back together using screws or to undergo a hip replacement – within two days have about half the risk of complications than those who wait longer.

“Most of the predictors of complication are non-modifiable. The one modifiable predictor is a wait in getting to the operating room greater than 48 hours,” says lead study author Philip J. Belmont, Jr., MD, an orthopaedic surgeon at the William Beaumont Army Medical Center.

“When somebody breaks their hip they’re very frail to begin with,” he says. “So if they lay in bed a few days they can develop pneumonia, blood clots, bedsores – and they get weaker very quickly.”

But, while timely treatment is important, it’s key to strike a balance, says Marc W. Hungerford, MD, director of Joint Replacement and Reconstruction at Mercy Medical Center in Baltimore.

“You don’t want to rush to the operating room,” he says. “Many of the patients have hypertension or have had a stroke or have other [medical issues]. In fact, if you had a strict 48-hour rule the fatality rate would probably go up because of significant medical issues not addressed.”

He notes that while you can’t make everyone perfectly healthy for surgery, you can “optimize” them.

The push to get patients into surgery faster wasn’t always the case. “When I first started my residency it was normal to wait five to six days to make sure the pre-operative work-up was done,” explains A. Alex Jahangir, MD, assistant professor of orthopaedic surgery and rehabilitation in the division of orthopaedic trauma at Vanderbilt University Medical Center in Nashville, Tenn.  Now, he says, unless the patient has a life-threatening condition, like a heart rhythm abnormality, doctors make an effort to get the patient into surgery.

Dr. Belmont points out that the vast majority of patients in the United States do get operated on within 24 hours following a hip fracture, but suggests the study underscores the need for orthopaedic surgeons to work closely with the rest of the medical team to ensure timely surgery is the standard for care.