Understanding and Improving Wait Times for Hip Fracture Surgery

Although wait times for hip fracture surgery are linked to mortality and used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications. Using new surgical wait time data from a population based cohort in Ontario, Canada, objectives of the thesis were to: 1) establish a safe time window in which to conduct hip fracture surgery before risk of complications rise; 2) determine whether delayed surgery is associated with higher medical costs; and 3) assess wait times across Ontario to determine where performance improvement efforts need to be targeted. Validated data from linked health administrative databases were used to identify 42,230 adults aged 45 years and older receiving hip fracture surgery from 522 different surgeons at 72 different hospitals in Ontario between April 1, 2009 and March 31, 2014. The risk of developing mortality and other medical complications consistently rose when surgery was delayed more than 24 hours, after risk adjustment, and independent of the outcome or follow-up period assessed. Medical costs and postoperative length of stay were also increased when surgery was delayed. Two-thirds (66%) of patients did not receive surgery within 24 hours, with more than half of hospitals (52%), compared to 4.8% of surgeons and 0.2% of anesthesiologists, showing significant differences in the risk-adjusted likelihood of delayed surgery. Variables strongly associated with delay included hospital transfer and preoperative echocardiography. Findings pertain to increasing numbers of patients experiencing hip fractures and the different medical and surgical specialists treating them and may inform existing hip fracture care guidelines and policies. Methods from this thesis may be used to report and evaluate inpatient wait times for other surgical procedures in Canada.Ph.D