OUP accepted manuscript

Abstract

Objective To analyse the trajectories of hip-fracture surgery rates within 2 days of admission to the hospital and the ratios of procedures initiated within the same day (day 0) and the following day (days 0-1) to procedures performed on the 2nd day. To study the association between socioeconomic , health input variables and early surgery. Design A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 15 European countries, during 2000/2013. Results The rate of patients aged ≥65 years that were operated on within 2 days of hip-fracture has changed over time with an EU average annual increase of 0.42% (95% IC = 0.25, 0.59; P < 0.001) and with a significant linear trend. Multiple slopes from all the countries compete with this result. In contrast, the ratios of procedures initiated within the same day (day 0) and the following day (days 0-1) compared to procedures performed on the 2nd day are constant. No association was found between the rate of patients treated within 2 days of admission and demographic structure, health expenditure, health resources. However, the rate of patients treated within 2 days of admission is significantly associated with surgical volumes. Conclusions As the early surgery rate is growing, policy makers should be encouraged to undertake further policies to support the quality of care, and the providers should be driven to improve their organizational effectiveness by taking actions aimed at acting on specific organizational and logistical causes that represent a barrier to early surgery.

Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy

“…This tentative result is coherent with a previous study showing that, together with an increase in surgical volumes, there is also an increase in the rate of hip fractures treated within two days of admission. 25 This study suggests that, when dealing with high volumes of patients, health systems and hospitals change their organization, deploying smart processes and managing healthcare workers in order to achieve organizational effectiveness, which is defined as the organization ability to achieve the outcomes that the organization intends to produce. [26][27][28][29] The steady increase in the hospitalization rate, probably due to an increase in outdoor traumas following the progressive removal of restrictions in May 2020, 30 seems to have enhanced and accelerated the ability to remodel the logistical and organizational management of trauma, with progressive reactivation of hospital beds and greater availability of operating rooms, a further definition of patient discharge procedures and a more efficient use of healthcare workers.…”