Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Metcalfe, David; Olufajo, Olubode A.; Zogg, Cheryl K.; Gates, Jonathan D.; Weaver, Michael J.; Harris, Mitchel B.; Rios-Diaz, Arturo J.; Haider, Adil H.; Salim, Ali

doi:10.1097/mlr.0000000000000535

Cited by 19 publications

(14 citation statements)

References 33 publications

(41 reference statements)

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“…Previous studies have shown an association between a higher volume of hip fracture surgeries and delays, complications and death. 40,41 The studies suggest underprioritization of hip fracture over other surgeries at high-volume sites. 40,41 Hospital occupancy has also been associated with risk of in-hospital death after hip fracture.…”

Section: Discussionmentioning

confidence: 99%

“…40,41 The studies suggest underprioritization of hip fracture over other surgeries at high-volume sites. 40,41 Hospital occupancy has also been associated with risk of in-hospital death after hip fracture. 31 Future research should explore the association among teaching status, bed capacity, occupancy and volume to better our understanding of outcomes of hip fracture care delivery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In-hospital mortality after hip fracture by treatment setting

Sobolev

Guy

Kuramoto

et al. 2016

CMAJ

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In-hospital mortality after hip fracture by treatment setting

Sobolev

Guy

Kuramoto

et al. 2016

CMAJ

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“…79 Resource availability depends on whether the prioritization places hip fracture cases over other urgent trauma cases. 20,41,80 Where implemented, policies on access to surgery have been intended to address a lesser priority for hip fracture surgery and shortened time to surgery in some hospitals. 3 The presence of an institution's access and discharge policy depends on the calendar period when a patient underwent surgery, conceptualized here as treatment era.…”

Section: Mediating Factorsmentioning

confidence: 99%

“…Hospital type Trauma center designation increases hospital workload, and hip fracture patients may be given lower priority than patients needing more urgent care in trauma centers. 80…”

Section: Structurementioning

confidence: 99%

Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.

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“…Some have argued that understanding the effects of policy change should guide reorganization of operating room resources 26 and prioritization in the presence of competing demand. 7,[27][28][29] In this paper, we offer 2 new estimates: the effect of possible changes in surgical timing policy in the same popula tion of patients, and the proportion of inhospital deaths attrib utable to surgical delays.…”

mentioning

confidence: 99%