Background Hip fracture is a common clinical problem that leads to considerable morbidity and mortality in the United Kingdom. Recommendations in our hospital suggest that elderly patients suffering from these fractures should have surgery within two calendar days from admission.

Methods From August 2002 to July 2003, we studied 407 patients over the age of 65 who had a fracture of the hip. (Cases were recorded prospectively in our department trauma database). This was to determine the effect of operative delay and patients age on in-hospital mortality and on post operative length of stay. An operative delay was defined as an interval more than two calendar days between the time of admission to the hospital and the operation.

Results In 199 (47%) cases, operation was performed within two calendar days from admission. The in-hospital mortality rate was 11%. The mean length of stay was 17 days.

In the cases studied, neither the operative delay nor the age of the patient had a significant effect on the length of stay post operation.

There was an increase in the in-hospital mortality rate associated with the operative delay, although this was not significant statistically.

There was a statistically significant increase in the inhospital mortality rate with an increase in the patients age (5 % if less than 80 years old, 11% if between 80 and 89 years old, 19% if 90 years or older, p is less or equal to 0.05). In all three age groups the mortality rate did not statistically significantly decrease if the surgery was performed within two calendar days from admission.

Conclusion Early surgery is not associated with significantly improved in-hospital mortality rate. Early surgery is not associated with decreased length of stay. Age is a prime factor in predicting the in-hospital mortality rate. We recommend early medical input for patient optimisation to reduce the proven high mortality rate.