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Khan et?al. [16], in a similar meta-analysis of 52 studies involving 291?413 patients, concluded that surgery within 48?h of admission after hip fractures reduced the length of hospital stay, the postoperative complication rate and peri-operative mortality rate. In a 3-year study of 129?522 patients aged 65?years or over admitted after hip fractures, Bottle and Aylin [6] noted http://www.selleck.cn/products/Methazolastone.html that case-adjusted mortality increased by 9.4% if surgery was delayed beyond 24?h. The BOAST 1 guidelines [17] suggest that: ��surgical fixation should not be delayed more than 48?h from admission unless there are clear reversible medical conditions��. Only half the hospitals in this study achieved a mean admission to operation time of http://www.selleckchem.com/products/Nutlin-3.html on patient throughput. We found a weak, non-significant, negative correlation between delay and 30-day postoperative mortality. Forty-two percent of all operations were delayed. Mean delay beyond 48?h was associated with a higher operation postponement rate (50% compared to 33%) than occurred in hospitals where mean delay was http://www.selleckchem.com/products/ABT-737.html (23% of 5447 patients ��medically unfit��) suggest significant inter-hospital variations with regard to clinical management of patients with hip fractures. There is considerable scope for further research into why some hospitals seemingly perform ��better�� than others in this area, by assessing, for example, the effectiveness of dedicated hip fracture units or teams, protected trauma operating lists, integrated care pathways, multidisciplinary care involving peri-operative physicians, gerontologists, surgeons and allied healthcare professionals, and availability of support facilities, including echocardiography and high dependency care. In this study, the 30-day postoperative mortality rate was 9%, similar to nationally reported figures of 8.3�C10% [11, 18]. However, it is difficult to interpret inter-hospital variations in mortality rate in this study. A high rate, for example, may have reflected a genuinely high mortality rate, or may have occurred as a statistical anomaly arising from a small number of additional deaths occurring among a small cohort of patients over the short time period of the study.