Boris Sobolev1, Pierre Guy2, Katie Jane Sheehan2, Lisa Kuramoto2, Jason M Sutherland2, Adrian R Levy2, James A Blair2, Eric Bohm2, Jason D Kim2, Edward J Harvey2, Suzanne N Morin2, Lauren Beaupre2, Michael Dunbar2, Susan Jaglal2, James Waddell2. 1. School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont. boris.sobolev@ubc.ca. 2. School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS: We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS: Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%). INTERPRETATION: Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
BACKGROUND: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS: We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS: Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%). INTERPRETATION: Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
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: Patrick Haentjens; Jay Magaziner; Cathleen S Colón-Emeric; Dirk Vanderschueren; Koen Milisen; Brigitte Velkeniers; Steven Boonen Journal: Ann Intern Med Date: 2010-03-16 Impact factor: 25.391
Authors: Syed Morad Hameed; Nadine Schuurman; Tarek Razek; Darrell Boone; Rardi Van Heest; Tracey Taulu; Nasira Lakha; David C Evans; D Ross Brown; Andrew W Kirkpatrick; Henry T Stelfox; Dianne Dyer; Mary van Wijngaarden-Stephens; Sarvesh Logsetty; Avery B Nathens; Tanya Charyk-Stewart; Sandro Rizoli; Lorraine N Tremblay; Frederick Brenneman; Najma Ahmed; Elsie Galbraith; Neil Parry; Murray J Girotti; Guiseppe Pagliarello; Nancy Tze; Kosar Khwaja; Natalie Yanchar; John M Tallon; J Andrew I Trenholm; Candance Tegart; Ofer Amram; Myriam Berube; Usmaan Hameed; Richard K Simons Journal: J Trauma Date: 2010-12
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: Pierre Guy; Katie J Sheehan; Suzanne N Morin; James Waddell; Michael Dunbar; Edward Harvey; Susan Sirett; Boris Sobolev; Lisa Kuramoto; Michael Tang Journal: BMJ Open Date: 2017-10-05 Impact factor: 2.692
Authors: Katie J Sheehan; Boris Sobolev; Pierre Guy; Jason D Kim; Lisa Kuramoto; Lauren Beaupre; Adrian R Levy; Suzanne N Morin; Jason M Sutherland; Edward J Harvey Journal: BMC Health Serv Res Date: 2020-10-10 Impact factor: 2.655
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: Jacobus D Jordaan; Marilize C Burger; Shafique Jakoet; Muhammad Ahmed Manjra; Johan Charilaou Journal: Geriatr Orthop Surg Rehabil Date: 2022-08-03