Journal Article

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada

Byrne, James P., Ravi, Bheeshma, Jenkinson, Richard J., Paterson, J. Michael, Wasserstein, David, Nathens, Avery B., Kreder, Hans J., Wodchis, Walter P., Huang, Anjie, Pincus, Daniel

2018

Overview

Although a delay of 24 hours for hip fracture repair is associated with medical complications and costs, it is unknown how long patients wait for surgery for hip fracture. We describe novel methods for measuring exact urgent and emergent surgical wait times (in hours) and the factors that influence them. Adults aged 45 years and older who underwent surgery for hip fracture (the most common urgently performed procedure) in Ontario, Canada, between 2009 and 2014 were eligible. Validated data from linked health administrative databases were used. The primary outcome was the time elapsed from hospital arrival recorded in the National Ambulatory Care Reporting System until the time of surgery recorded in the Discharge Abstract Database (in hours). The influence of patient, physician and hospital factors on wait times was investigated using 3-level, hierarchical linear regression models. Among 42 230 patients with hip fracture, the mean (SD) wait time for surgery was 38.76 (28.84) hours, and 14 174 (33.5%) patients underwent surgery within 24 hours. Variables strongly associated with delay included time for hospital transfer (adjusted increase of 26.23 h, 95% CI 25.38 to 27.01) and time for preoperative echocardiography (adjusted increase of 18.56 h, 95% CI 17.73 to 19.38). More than half of the hospitals (37 of 72, 51.4%), compared with 4.8% of surgeons and 0.2% of anesthesiologists, showed significant differences in the risk-adjusted likelihood of delayed surgery. Exact wait times for urgent and emergent surgery can be measured using Canada’s administrative data. Only one-third of patients received surgery within the safe time frame (24 h). Wait times varied according to hospital and physician factors; however, hospital factors had a larger impact.

• Publisher: Elsevier Inc,CMA Impact, Inc,Joule Inc
• Subject: Aged / Aged, 80 and over / Ambulatory care / Comorbidity / Cross-Sectional Studies / Emergency Medical Services / Emergency Service, Hospital - statistics & numerical data / Female / Fracture Fixation, Internal - statistics & numerical data / Fractures / Health risk assessment / Hip Fractures - mortality / Hip Fractures - surgery / Hip joint / Hospitals / Humans / Internal Medicine / Male / Medical waiting lists / Middle Aged / Ontario - epidemiology / Outcome and Process Assessment, Health Care / Surgery / Surgical outcomes / Systematic review / Time-to-Treatment - statistics & numerical data / Trauma / Treatment Outcome / Variables / Waiting Lists - mortality