Introduction: We present the use of Orthopaedic POSSUM Score and Surgical Risk Score (SRS) in femoral neck fracture surgery. The objective of this study was to identify the physiological status at admission and at operation and identify differences in predictive and actual patient operative outcomes.

Material and Methods: All 338 consecutive, hip fractures from December to July 2005 at three hospitals were assessed prospectively. Collection of demographic, admission, and operative POSSUM, and SRS scores, fracture pathology, physiological status, and outcomes were analyzed.

Results: In total, 306 (90.5%) patients had surgery. The median age was 73 years (range 55–95). The majority had co-morbidities (77.5%; n=237), as suggested by average ASA scores of 3.2. POSSUM predicted mortality was 13.6% (n=25) at 30 days, whereas the SRS predicted 11.4% (n=21), but mortality was 7.1% (n=13) if operated before 48 hours. Differences between admission and operative physiological Possum score increased with operative delay. Physiological scores over 30 had a 67.8% risk of 30-day mortality. Eighty-six patients had an increase in physiological score from admission to operation, resulting in higher analgesic requirements and reduced mobility scores (P< 0.005).

Discussion: Possum and SRS had a tendency to predict prior than actual operative mortality. Nevertheless, comparison of admission and operative physiological POSSUM scores indicate room for improvement in pre-operative care if surgery is delayed.