Debate: The 24 hour Time to Surgery Standard for Hip Fractures May Be Harming Patients. .

Hip fracture care raises a key question: how fast should patients get to surgery? A large multinational RCT comparing accelerated surgery at about 6 hours to usual care showed no overall mortality benefit, but revealed an important nuance—patients with elevated troponins had dramatically lower 90-day mortality and fewer major complications when surgery was expedited. An observational meta-analysis of nearly 190,000 patients supported earlier treatment in general but suggested no added benefit when surgery occurred within 12 hours. Taken together, RCT methods provide stronger protection against confounding, making the accelerated 6-hour target more convincing for high-risk patients, while a 24-hour window remains reasonable for healthier individuals.