CIHI Survey: Wait Time for Hip Fracture Surgery in Canada

Tracey, Jacinth; Forte, Tonia; Fagbemi, Josh; Chaudhary, Zeerak

doi:10.12927/hcq.2013.19310

Cited by 12 publications

(9 citation statements)

References 4 publications

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“…In particular, the time to surgery depends on the treating hospital type [36][37][38] and its available resources, including operating rooms, [39][40][41][42] nursing staff, 43 surgeons, 39 specialists 23,44 and laboratory tests 23,41,44 Resource availability depends on the time of admission, with resources being less available "after hours" than during regular working hours. 42,[45][46][47] The risk also depends on the type of surgery itself, because arthroplasty requires additional resources, such as a surgeon with arthroplasty experience and implants that may not be kept in stock. 3,23 The risk of a delay to surgery also depends on the overall demand for services, which may exceed available resources.…”

Section: Dependency Graphmentioning

confidence: 99%

“…70 The time of admission depends on the need for transfers before definitive care, because patients who are transferred are more likely to be admitted late in the day than patients who are admitted directly. 46 Following inclusion of these other dependencies, we identified two additional factors that produce variation in both time to surgery and postoperative in-hospital death. First, age produces variation in time to surgery through fitness for surgery, 49 and also produces variation in postoperative in-hospital death through chronic conditions and complications.…”

Section: Common Factorsmentioning

confidence: 99%

“…Patients who undergo transfer are more likely to be admitted to the treatment site later in the day. 46 Late admission…”

Section: Process Transfermentioning

confidence: 99%

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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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Section: Dependency Graphmentioning

confidence: 99%

Section: Common Factorsmentioning

confidence: 99%

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Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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“…In 2005, almost 297,000 hip fractures occurred in USA, resulting in an annual burden of care of approximately $12 billion [4]. Like OA, the occurrence of hip fracture rises with increasing age, with 88 % of hip fracture-related admissions to hospitals occurring in individuals aged ≥65 years [5]. Both OA and hip fracture are associated with significant mobility impairment [6][7][8], activity limitations [6,7,9], and pain [6,10].…”

Section: Introductionmentioning

confidence: 99%

Risk of hip fracture with hip or knee osteoarthritis: a systematic review

et al. 2012

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“…3 Yet, it remains unclear whether delayed access and reduced resources following after-hours admissions or procedures increases the risk of death. [4][5][6] The Canadian Collaborative Study on Hip Fractures will explore the effect of after-hours admission time, procedure volume and bed occupancy on risk of death after hip fracture. 7 Further, the British Columbia Hip Fracture Redesign Project is collecting prospective data on procedure time to determine the effect of after-hours procedures on outcomes.…”

mentioning

confidence: 99%