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Osteoporos Int. 2018 Mar;29(3):653-663. doi: 10.1007/s00198-017-4333-4. Epub 2017 Dec 6.

Time to surgery after hip fracture across Canada by timing of admission.

Author information

1
Academic Department of Physiotherapy, School of Population Health and Environmental Sciences, Guy's Campus, King's College London, London, UK. katie.sheehan@kcl.ac.uk.
2
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
3
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
4
Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
5
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
6
Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada.
7
Department of Medicine, McGill University, Montreal, QC, Canada.
8
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
9
Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
10
Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada.

Abstract

The extent of Canadian provincial variation in hip fracture surgical timing is unclear. Provinces performed a similar proportion of surgeries within three inpatient days after adjustment. Time to surgery varied by timing of admission across provinces. This may reflect different approaches to providing access to hip fracture surgery.

INTRODUCTION:

The aim of this study was to compare whether time to surgery after hip fracture varies across Canadian provinces for surgically fit patients and their subgroups defined by timing of admission.

METHODS:

We retrieved hospitalization records for 140,235 patients 65 years and older, treated surgically for hip fracture between 2004 and 2012 in Canada (excluding Quebec). We studied the proportion of surgeries on admission day and within 3 inpatient days, and times required for 33%, 66%, and 90% of surgeries across provinces and by subgroups defined by timing of admission. Differences were adjusted for patient, injury, and care characteristics.

RESULTS:

Overall, provinces performed similar proportions of surgeries within the recommended three inpatient days, with all provinces requiring one additional day to perform the recommended 90% of surgeries. Prince Edward Island performed 7.0% more surgeries on admission day than Ontario irrespective of timing of admission (difference = 7.0; 95% CI 4.0, 9.9). The proportion of surgeries on admission day was 6.3% lower in Manitoba (difference = - 6.3; 95% CI - 12.1, - 0.6), and 7.7% lower in Saskatchewan (difference = - 7.7; 95% CI - 12.7, - 2.8) compared to Ontario. These differences persisted for late weekday and weekend admissions. The time required for 33%, 66%, and 90% of surgeries ranged from 1 to 2, 2-3, and 3-4 days, respectively, across provinces by timing of admission.

CONCLUSIONS:

Provinces performed similarly with respect to recommended time for hip fracture surgery. The proportion of surgeries on admission day, and time required to complete 33% and 66% of surgeries, varied across provinces and by timing of admission. This may reflect different provincial approaches to providing access to hip fracture surgery.

KEYWORDS:

Hip fracture; Quantile regression; Time to surgery; Timing of admission; Variation

PMID:
29214329
DOI:
10.1007/s00198-017-4333-4

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