Daniel Pincus1, David Wasserstein2, Bheeshma Ravi2, James P Byrne2, Anjie Huang2, J Michael Paterson2, Avery B Nathens2, Hans J Kreder2, Richard J Jenkinson2, Walter P Wodchis2. 1. Department of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont. d.pincus@utoronto.ca. 2. Department of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. INTERPRETATION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. INTERPRETATION: 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.
Authors: Shahid Shafi; Avery B Nathens; H Gill Cryer; Mark R Hemmila; Michael D Pasquale; David E Clark; Melanie Neal; Sandra Goble; J Wayne Meredith; John J Fildes Journal: J Am Coll Surg Date: 2009-08-13 Impact factor: 6.113
Authors: Katie J Sheehan; Boris Sobolev; Pierre Guy; Lisa Kuramoto; Suzanne N Morin; Jason M Sutherland; Lauren Beaupre; Donald Griesdale; Michael Dunbar; Eric Bohm; Edward Harvey Journal: CMAJ Date: 2016-10-17 Impact factor: 8.262
Authors: María T Vidán; Elisabet Sánchez; Yassira Gracia; Eugenio Marañón; Javier Vaquero; José A Serra Journal: Ann Intern Med Date: 2011-08-16 Impact factor: 25.391
Authors: Pasqualina L Santaguida; Gillian A Hawker; Pamela L Hudak; Richard Glazier; Nizar N Mahomed; Hans J Kreder; Peter C Coyte; James G Wright Journal: Can J Surg Date: 2008-12 Impact factor: 2.089
Authors: Zachary Thomas Crawford; Brendan Southam; Robert Matar; Frank R Avilucea; Katherine Bowers; Mekibib Altaye; Michael T Archdeacon Journal: Geriatr Orthop Surg Rehabil Date: 2020-10-16
Authors: Emil Schemitsch; Jonathan D Adachi; Jacques P Brown; Jean-Eric Tarride; Natasha Burke; Thiago Oliveira; Lubomira Slatkovska Journal: Osteoporos Int Date: 2021-08-11 Impact factor: 4.507
Authors: Louis de Jong; Veronique van Rijckevorsel; Taco M A L Klem; Martijn Kuijper; Gert R Roukema Journal: BMJ Open Date: 2020-09-29 Impact factor: 2.692