Time to surgery and transfer‐associated mortality for hip fractures in Western Australia

Lawless, Adam; Narula, Siddarth; D’Alessandro, Peter; Jones, Christopher W.; Seymour, Hannah; Yates, Piers

doi:10.1111/ans.16115

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…In our large study of NSW people with hip fractures, we found that transfer from non‐operating to operating hospitals, after adjusting for patient and hospital characteristics, was not associated with higher 30‐day mortality, despite increasing the time between initial presentation and surgery. This is contrary to the findings of earlier, single centre studies in Australia 4‐6 . However, our study was the first to control for several key person‐level factors that increase the risk of death, and our findings suggest that time to surgery may be less important for health outcomes than these factors when other dimensions of care quality are equal.…”

contrasting

confidence: 99%

Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures

Harvey

Harris

Mitchell

et al. 2021

Medical Journal of Australia

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confidence: 99%

Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures

Harvey

Harris

Mitchell

et al. 2021

Medical Journal of Australia

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“…There have been no large-scale or long-term observational studies reviewing time to surgery based on regions within WA. One smaller study looking at a single institution found a 12-hour delay to surgery in patients that required an inter-hospital transfer which was associated with increased mortality [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Tyranny of Distance: How Hospital Transfer Affects Time to Surgery for Hip Fracture Patients

Marley¹,

Lambers²,

Marley³

et al. 2022

Cureus

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IntroductionIn Western Australia, vast distances between hospitals can limit a patient's access to timely surgical intervention. The aim was to examine the effect of patient location on outcomes. MethodsHip fracture data from all operative cases at the major Western Australian hospitals between 2015 and 2019 was retrospectively reviewed. A total of 5691 patients were separated into three groups based on hospital of first presentation -directly to the operative hospital (metropolitan), a hospital less than 2.5 hours by road from the operative centre (outer-metropolitan), or requiring transfer by air (rural). Impact of location on time to surgery, length of stay and 30-day and 120-day mortality was analysed. ResultsThe mean time to surgery was 26.7 hours for metropolitan patients, 37.0 hours for outer-metropolitan, and 42.6 hours for rural patients. Outer-metropolitan patients were less likely to reach surgery within 48 hours than metropolitan patients (80.2% vs 91.5%, p<0.001), with even lower rates for rural patients (66.8%, p<0.001). Acute length of stay was longer for rural patients compared to outer-metropolitan (7.2 vs 5.8 days) and metropolitan patients (5.5 days) (p<0.001). There was no significant difference in 30-day or 120-day mortality for outer-metropolitan or rural patients compared to metropolitan patients despite requiring transfer. However, when considered as a whole group there was an increased 120-day mortality with increased time to surgery. Overall mortality was 8.7% at 30 days and 17.3% at 120 days. ConclusionPatients presenting outside the metropolitan area with a hip fracture have a longer time to surgery and longer length of stay. Delay for outer-metropolitan patients is disproportionately longer than transit time alone and may provide opportunities for improvement.

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“…Interhospital transfer is an independent predictor of mortality in surgical patients, 17,18 regardless of time to surgery or number of comorbidities, 19,20 which is associated with increased complications, duration of stay, treatment costs and places greater demand on clinical resources than direct admissions from the emergency department. [21][22][23][24] By extension, any delays in patient transfer lead to further delays with surgery and result in longer inpatient stay.…”

Section: Introductionmentioning

confidence: 99%

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Young

Kopunic

Trochsler

et al. 2022

ANZ Journal of Surgery

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Time to surgery and transfer‐associated mortality for hip fractures in Western Australia

Abstract: This study evaluated hip fracture transfer times, delays to definitive surgery affecting mortality and the negative impact of patient transfer on outcomes.

Cited by 10 publications

References 10 publications

Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures

Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures

The Tyranny of Distance: How Hospital Transfer Affects Time to Surgery for Hip Fracture Patients

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

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