Objective      To study the influence of timing of surgery on postoperative curative effect in nonagenarians with hip fracture.       Methods      A total of 75 nonagenarians with hip fracture in our department from January 2002 to February 2014 were enrolled and retrospectively analyzed. There were 21 males and 54 females with a mean age of 92.35±2.60 (ranged from 90 to 99). There were 34 cases of femoral neck fracture and 41cases of intertrochanteric fracture. All the patients were divided into 3 groups: an early surgery group (operated within 48 h

n=27)

a delayed surgery group (operated between 48 and 72 h

n=18) and a late surgery group (operated after 72 h

n=30). After admission

the relatively healthy nonagenarians received early surgery

while the fragile ones received appropriate postponement and damage control surgery. Clinical indicators such as preoperative assessments

comorbidities

operation related indexes

and so on were collected and analyzed. The mortalities

complications and survival curves during postoperative hospitalization were compared.       Results      The mean types of comorbidities in the early

delayed and late surgery groups were 3.04±1.91

4.06±1.59

and 4.13±1.61

respectively

and the number of the late surgery group was higher than that of the early surgery group (P=0.019). The cardiac disease rate of the late surgery group (4 cases) was higher than that (3 cases) of the early surgery group and that (1 case) of the delayed surgery group (P=0.044). The before-injury activities of daily living (ADL) scores of the early

delayed and late surgery groups were 68.89±8.70

67.50±8.95

and 62.83±7.73

respectively

and the scores of the late surgery group were lower than those of the early surgery group (P=0.008). The patients in the late surgery group experienced relatively long hospitalization period (P0.05). There were no statistically significant differences in the gender

age

American society of anesthesiologists (ASA) classification

type of hip fracture

anesthesia manner and operation manner among the three groups (P0.05). The incidences of complications and mortalities in 1

3 and 6 months after surgery showed no significant differences among the 3 groups (P0.05)

as well as the survival curves (P=0.253).       Conclusion      Appropriate postponement and damage control surgery is safe and effective for alleviating major clinical abnormalities before surgery

by which the survival conditions of the fragile nonagenarians can reach the levels of the relatively healthy ones.