Improvements needed to enhance access to urgent hip fracture procedures

Only one third of patients with hip fractures in Ontario receive surgery within a recommend 24 hour window, with wide variation in the time patients wait depending on where they are treated, reports a Sunnybrook-led study.

“Though we’ve come a long way, further improvements and more resources are needed for this vulnerable patient population, in a health-care setting where hip fracture surgery is already the most commonly performed urgent procedure,” says study author Dr. Daniel Pincus, an orthopaedic resident physician at Sunnybrook, and PhD student at the University of Toronto and Institute for Clinical Evaluative Sciences.

Current time-to-surgery guidelines in Canada and the United State recommend procedures within 48 hours, and 36 hours in the United Kingdom. In a previous study, the same researchers found that after the 24-hour time-to-surgery window, the risk of mortality and developing complications begins to increase.

In this study, the researchers looked at potential factors influencing the time patients had to wait for hip fracture surgery, including:

• gender and the age of patients and their co-existing medical conditions
• the range of hospitals: academic, large community, small/medium community
• each hospital’s capacity to perform non-elective or urgent surgeries

They also identified important and modifiable risk factors to delayed surgery. Transfers — where patients are transported from one hospital another for a hip fracture procedure — were linked to more than one day of additional delay. Pre-surgery consultations and echocardiography testing were also associated with significant delays.

To improve time-to-surgery, the researchers suggest more optimal transfers of patients for surgery, avoiding unnecessary preoperative testing, and designating urgent surgical centres in larger communities that can support ongoing daytime urgent surgeries.

This population-based, observational study looked at 42,230 adults aged 45 years and up who underwent surgery for hip fracture in Ontario from April 1, 2009 and March 31, 2014.

Authors: Pincus, D, Wasserstein, D, Ravi, B, Byrne, J, Huang, A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson R, Wodchis

This study was generously supported by the Marvin Tile Chair in Orthopaedic Surgery at Sunnybrook Health Sciences Centre, and by the Institute for Clinical Evaluative Sciences. Daniel Pincus is supported by the Canadian Institutes of Health Research Vanier Scholarship Program.