Ho, ho, ho! Gather around, my dear friends, for I have a tale to tell, not of elves and reindeer, but of wisdom and care, especially for those who’ve had a bit of a tumble. You see, in the land of medicine, there’s been quite the stir about folks who’ve taken a spill from no higher than a snowdrift, yet found themselves with a hip fracture. Now, these aren’t your ordinary adventurers; they’re wise elders, aged 65 and above, who’ve seen many a Christmas.

From 2013 to 2021, the clever elves, I mean researchers, delved into the TQIP dataset, a treasure trove of knowledge, to understand the plight of 254,400 patients who, after a ground-level fall, needed their hips fixed with a bit of surgical magic. Their quest? To see if waiting more than 24 hours to perform this magic would turn the recovery journey into a perilous one, especially for those already treading carefully due to frailty or a heart that’s danced to many a tune.

Using a sprinkle of inverse probability weighting (IPW) magic to make sure they were comparing apples to apples, or in our case, snowflakes to snowflakes, they assessed each patient’s frailty with the Orthopedic Frailty Score (OFS) and their heart’s readiness for the journey with the Revised Cardiac Risk Index (RCRI). What they sought was simple: did delaying surgery turn the hospital stay into a riskier adventure?

And oh, what they found! Delaying surgery for more than a day was like waiting too long to open presents; it just made things worse. For those with a hearty constitution but fragile bones (OFS ≥4), waiting meant a 2.33 percentage point increase in the chance of not making it home for Christmas dinner, with a number needed to harm (NNH) of 43. And for those whose hearts were already weary from many a sleigh ride (RCRI ≥4), the risk jumped by 4.65 percentage points if surgery was delayed, with an NNH of 22. Even for the sturdiest of elves, with no frailty or cardiac risk, the risk was there, though much like finding a needle in a haystack (or a single snowflake in a blizzard).

So, my dear friends, the moral of this tale is clear: when it comes to fixing broken hips in our cherished elders, time is of the essence. Delaying surgery is akin to postponing Christmas—it just shouldn’t be done, no matter how frail the patient or how weary the heart. For in the end, a timely fix can mean the difference between a merry recovery and a journey fraught with risk. And with that, I wish you all a healthy, happy, and prompt recovery, should you ever find yourself in such a predicament. Merry fixing to all, and to all a good night!