Variation in surgical demand and time to hip fracture repair: a Canadian database study

BMC Health Services Research

Lisa Kuramoto¹  Jason M. Sutherland²  Pierre Guy³  Adrian R. Levy⁴  Suzanne N. Morin⁵  Lauren Beaupre⁶  Katie J. Sheehan⁷  Edward J. Harvey⁸  Jason D. Kim⁹  Boris Sobolev⁹ 

[1] Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada;Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbi, Vancouver, British Columbia, Canada;Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada;Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada;Department of Medicine, McGill University, Montreal, Quebec, Canada;Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada;Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK;Division of Orthopaedic Surgery, McGill University, Montreal, Canada;School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada;

关键词: Hip fracture;    Time to surgery;    Surgical delay;    Demand;    Variation;   

DOI  :  10.1186/s12913-020-05791-5

来源: Springer

【 摘 要 】

BackgroundCompeting 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.MethodsWe 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.ResultsFor 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.ConclusionIncreases 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.

【 授权许可】

CC BY