*Article* **Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study**

**Norio Yamamoto 1,2,3, Hiroyuki Ohbe 4,\*, Yosuke Tomita 5, Takashi Yorifuji 2, Mikio Nakajima 4,6, Yusuke Sasabuchi 7, Yuki Miyamoto 4,8, Hiroki Matsui 4, Tomoyuki Noda <sup>9</sup> and Hideo Yasunaga <sup>4</sup>**


**Abstract:** Previous literature has provided conflicting results regarding the associations between early surgery and postoperative outcomes in elderly patients with distal femur fractures. Using data from the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019, we identified elderly patients who underwent surgery for distal femur fracture within two days of hospital admission (early surgery group) or at three or more days after hospital admission (delayed surgery group). Of 9678 eligible patients, 1384 (14.3%) were assigned to the early surgery group. One-to-one propensity score matched analyses showed no significant difference in 30-day mortality between the early and delayed groups (0.5% versus 0.5%; risk difference, 0.0%; 95% confidence interval, −0.7% to 0.7%). Patients in the early surgery group had significantly lower proportions of the composite outcome (death or postoperative complications), shorter hospital stays, and lower total hospitalization costs than patients in the delayed surgery group. Our results showed that early surgery within two days of hospital admission for geriatric distal femur fracture was not associated with a reduction in 30-day mortality but was associated with reductions in postoperative complications and total hospitalization costs.

**Keywords:** distal femur fracture; surgical timing; mortality; complications; length of hospital stay; medical costs; database
