A medical fee incentive based on a 48-h target time for hip fracture surgery has been implemented in Japan since 2022. This study aimed to evaluate the clinical outcomes of early surgery within 48 h after hip fracture.

This study was a retrospective, single-center study. Patients >60 years of age who underwent hip fracture surgery between 2021 and 2022 were eligible. They were divided into 2 groups: 2021 (before implementation of the system) and 2022 (after implementation of the system). The primary outcome was the surgical waiting time after injury. The secondary outcomes were clinical outcomes such as postoperative complication rate, mortality rate at 1 and 6 months after surgery, and length of stay in our institution. To assess the influence of early surgery on these outcomes, an additional analysis was performed in 2 groups: the early group (surgery within 48 h) and the delayed group (surgery beyond 48 h).

In total, 365 patients were included in this study. The surgical waiting time was significantly shortened after the implementation of the system (64.5 h in 2021 vs. 42.8 h in 2022, p < 0.001). There were significant differences between the 2021 and 2022 groups in the complication rate (17 % vs. 9 %, p = 0.03) and length of hospital stay (15 days vs. 13 days, p < 0.001). A multivariate analysis between the early and delayed group showed that early surgery was associated with a lower complication rate and shorter length of stay (p < 0.05).

Efforts to perform early surgery within 48 h of injury following the new reimbursement scheme have contributed to improved clinical outcomes, including lower complication rates and shorter hospital stay in our institution.

Hip fracture

Early surgery

Medical fee incentive

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