48-Hour Benchmark for Hip Fracture Surgery for Older Adults
The Canadian Collaborative Study of Hip Fractures
Each year, Canadian hospitals admit over 25,000 older men and women with fracture of the hip. Overall, two-thirds of these patients receive surgical treatment on the day of admission or the next day, but the timing of surgery varies widely across the country. Canada’s health ministers have adopted 48 hours after admission as a benchmark for provision of hip fracture surgery. However, current evidence is insufficient to justify the changes in hospital care that would be required to prioritize access to this procedure.
This knowledge gap is important, because of the pressing need to identify patients who will benefit from accelerating their surgery through the 48-hour commitment.
What we're doing
In this population-based study we will use the Canadian Institute for Health Information Discharge Abstract Database to identify patients admitted for hip fracture surgery to any acute care hospital in Canada between 2003 and 2012. Comparisons will be made in health outcomes among patients exposed to various wait times before surgery and across subgroups of patients stratified by various patient and system related reasons for delay. We will test whether preoperative deaths were more frequent among Canadian hip fracture patients 65 years of age or older who remained untreated at 48 hours after admission. We will also determine whether postoperative complications and ensuing in-hospital deaths were more frequent when surgery was performed beyond 48 hours after admission.
Wishing everyone a Happy New Year! Collaborative members will be meeting in the coming weeks to discuss plans for 2017. Our CMAJ article has generated interest in the community. A letter responding to the article was recently published.
Boris and Pierre will present their session “Hip fracture care redesign in BC: 3-year follow up” at the International Forum on Quality & Safety in Healthcare.
We have also been invited to submit an article to the COA Winter Bulletin.
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Why this work is important
The significance of this research arises from the opportunity to supplement existing knowledge about the benefits of expeditious hip fracture surgery with evidence from real-life care delivered to a large number of patients across the entire country. Our study will improve understanding of the pathways linking waits and health outcomes through a comparison of two types of in-hospital deaths, those occurring before surgery and those occurring after surgical complications. Finally the study will identify groups of patients who would benefit from accelerated access to the procedure in terms of fewer complications and deaths.
In-hospital mortality after hip fracture by treatment setting.
Sheehan et al. Canadian Medical Association Journal 2016. doi:10.1503/cmaj.160522
Time trends in hospital stay after hip fracture in Canada, 2004-2012: database study.
Sobolev et al. Archives of Osteoporosis. 2016;11:13.
Constructing an episode of care from acute hospitalization records for studying effects of timing of hip fracture surgery.
Sheehan et al. Journal of Orthopedic Research 2016; 34:197-204.
“Hip fracture mortality by teaching status of treating hospital”
International Society for Quality in Health Care International Conference
Podium presentation (Katie Sheehan)
Tokyo, Japan, October 16, 2016 – October 19, 2016
Who we are
Led by Drs. Pierre Guy and Boris Sobolev a collaboration of researchers across Canada was awarded a Canadian Institute for Health Research Operating Grant to evaluate the 48 hour benchmark for hip fracture surgery.