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Variation in surgical demand and time to hip fracture repair: a Canadian database study Sheehan, Katie J; Sobolev, Boris; Guy, Pierre; Kim, Jason D.; Kuramoto, Lisa; Beaupre, Lauren; Levy, Adrian R.; Morin, Suzanne N.; Sutherland, Jason M.; Harvey, Edward J.

Abstract

Background: Competing demands for operative resources may affect time to hip fracture surgery. We sought to determine the time to hip fracture surgery by variation in demand in Canadian hospitals. Methods: We obtained discharge abstracts of 151,952 patients aged 65 years or older who underwent surgery for a hip fracture between January, 2004 and December, 2012 in nine Canadian provinces. We compared median time to surgery (in days) when demand could be met within a two-day benchmark and when demand required more days, i.e. clearance time, to provide surgery, overall and stratified by presence of medical reasons for delay. Results: For persons admitted when demand corresponded to a 2-day clearance time, 68% of patients underwent surgery within the 2-day benchmark. When demand corresponded to a clearance time of one week, 51% of patients underwent surgery within 2 days. Compared to demand that could be served within the two-day benchmark, adjusted median time to surgery was 5.1% (95% confidence interval [CI] 4.1–6.1), 12.2% (95% CI 10.3–14.2), and 22.0% (95% CI 17.7–26.2) longer, when demand required 4, 6, and 7 or more days to clear the backlog, respectively. After adjustment, delays in median time to surgery were similar for those with and without medical reasons for delay. Conclusion: Increases in demand for operative resources were associated with dose-response increases in the time needed for half of hip fracture patients to undergo surgery. Such delays may be mitigated through better anticipation of day-to-day supply and demand and increased response capability.

Item Metadata

Title
Variation in surgical demand and time to hip fracture repair: a Canadian database study
Creator
Sheehan, Katie J; Sobolev, Boris; Guy, Pierre; Kim, Jason D.; Kuramoto, Lisa; Beaupre, Lauren; Levy, Adrian R.; Morin, Suzanne N.; Sutherland, Jason M.; Harvey, Edward J.
Contributor
Centre for Hip Health and Mobility; Vancouver Coastal Health Authority. Centre for Clinical Epidemiology and Evaluation; University of British Columbia. Centre for Health Services and Policy Research
Publisher
BioMed Central
Date Issued
2020-10-10
Description
Background: Competing demands for operative resources may affect time to hip fracture surgery. We sought to determine the time to hip fracture surgery by variation in demand in Canadian hospitals. Methods: We obtained discharge abstracts of 151,952 patients aged 65 years or older who underwent surgery for a hip fracture between January, 2004 and December, 2012 in nine Canadian provinces. We compared median time to surgery (in days) when demand could be met within a two-day benchmark and when demand required more days, i.e. clearance time, to provide surgery, overall and stratified by presence of medical reasons for delay. Results: For persons admitted when demand corresponded to a 2-day clearance time, 68% of patients underwent surgery within the 2-day benchmark. When demand corresponded to a clearance time of one week, 51% of patients underwent surgery within 2 days. Compared to demand that could be served within the two-day benchmark, adjusted median time to surgery was 5.1% (95% confidence interval [CI] 4.1–6.1), 12.2% (95% CI 10.3–14.2), and 22.0% (95% CI 17.7–26.2) longer, when demand required 4, 6, and 7 or more days to clear the backlog, respectively. After adjustment, delays in median time to surgery were similar for those with and without medical reasons for delay. Conclusion: Increases in demand for operative resources were associated with dose-response increases in the time needed for half of hip fracture patients to undergo surgery. Such delays may be mitigated through better anticipation of day-to-day supply and demand and increased response capability.
Subject
Hip fracture; Time to surgery; Surgical delay; Demand; Variation
Genre
Article
Type
Text
Language
eng
Date Available
2020-10-15
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0394741
URI
http://hdl.handle.net/2429/76285
Affiliation
Medicine, Faculty of; Other UBC; Non UBC; Population and Public Health (SPPH), School of
Citation
BMC Health Services Research. 2020 Oct 10;20(1):935
Publisher DOI
10.1186/s12913-020-05791-5
Peer Review Status
Reviewed
Scholarly Level
Faculty
Copyright Holder
The Author(s)
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Rights

Attribution 4.0 International (CC BY 4.0)