OBJECTIVECurrent guidelines indicate that surgery for femoral neck fracture should be performed within 24 hours. But the effect of early surgery on mortality was not consistent with each other. This study is to explore the effect of early surgery on the risk of death among elderly patients with femoral neck fracture.

METHODSBy searching Medline, PubMed, CENTRAL (the Cochrane central register of controlled trials), CBM, CNKI and VIP et al, published documents about studies of early surgery VS delayed surgery on mortality for femoral neck fractures were collected. The data were analysised by using statistic software Stata 11.0. Random or fixed effect models were applied to conduct meta analysis on the study results, the combined relative risk (RR) and the 95% confidence interval (CI) were calculated as well.

RESULTSSix cohort studies and 8 430 patients were included in the combined analysis,which indicated that 64% death risk was observed in the early surgery group compared to the delayed surgery group (RR = 0.64, 95% CI: 0.55-0.73, P = 0.000). The death was divided into two subgroups: one was early death with 30 days and the other was late death after 6 months. For the early death, there was no statistic significance between early surgery and delayed surgery (RR = 0.93, 95% CI: 0.69-1.18, P = 0.076). And for the late death, only 59% death risk was observed in the early surgery group (RR = 0.59, 95% CI: 0.49-0.69, P = 0.000) compared to the delayed surgery group.

CONCLUSIONEarly surgery was associated with a lower risk of death for femoral neck fracture patients.