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

Abstract

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.

Pre‐operative femoral nerve block for hip fracture—A systematic review with meta‐analysis

“…The annual, global incidence of hip fractures is expected to increase from 1.66 million in 1990 to 6.26 million by 2050 . Pre‐operative analgesics is necessary especially if patients risk having a prolonged waiting time for surgery . Pre‐operative pain from hip fractures can be treated in several ways.…”

The association of female sex with application of evidence-based practice recommendations for perioperative care in hip fracture surgery

“…Perioperative geriatric care (identified using validated billing codes cross-referenced to the ICES Physician Database 31 ) was the primary outcome because its effectiveness is supported by high-level evidence for decreased mortality and length of stay. 21 Secondary outcomes were as fol-lows: surgical delay of more than 48 hours (identified from the DAD 17,32 ), which is associated with increased mortality and complications; 17,18 preoperative anesthesiology consults (identified using previously studied billing codes 33,34 ), which is associated with decreased case cancellations, costs and length of stay; regional analgesia (identified using previously studied billing codes 35 ), which improves analgesia and decreases pneumonia; 20 and neuraxial anesthesia (identified from validated fields in the DAD 36 ), which is associated with decreased length of stay and thromboembolism risk. 37,38 Specifics of validation studies are provided in Appendix 1 (available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.180564/-/DC1).…”

Strong administrative support needed to improve wait times for hip fracture

“…I would like to praise Pincus and colleagues for their article on wait times for urgent hip fracture surgery 1 and commend them for their ongoing work. As a community-based orthopedic surgeon who works in a medium-sized hospital servicing rural and very rural areas, I believe there is an area identified in the article that merits further review in the scope of rural practice -that hospitallevel delays seem to be at the root of much variation in wait times.…”

“…The authors suggest that hip fracture care needs to be streamlined and have clear algorithms, such as the one developed in Manitoba. 1,2 This initiative focused on expediting transfers, cutting down on unnecessary preoperative tests and steps, increasing the availability of operating room time for hip fractures, and collaboration with referral centres to repatriate patients postoperatively. Although this model is efficacious and is likely to be embraced by surgeons and patients alike, without strong administrative support, it remains an unachievable aspiration.…”