scholarly journals High volumes of recent surgical admissions, time to surgery, and 60-day mortality

2021 ◽  
Vol 103-B (2) ◽  
pp. 264-270
Author(s):  
Sara Marie Nilsen ◽  
Andreas Asheim ◽  
Fredrik Carlsen ◽  
Kjartan Sarheim Anthun ◽  
Lars Gunnar Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Volume ◽  
Surgical Patients ◽  
Hospital Capacity ◽  
Delayed Surgery ◽  
Time To Surgery ◽  
Hip Fracture Surgery ◽  
Mortality Hazard Ratio ◽  
Fracture Surgery ◽  
Surgical Admission

Aims Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. Methods This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. Results Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). Conclusion A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264–270.

Can Payment by Results Improve Hip Fracture Surgery Delays?

2010 ◽  
Vol 92 (7) ◽  
pp. 1-3
Author(s):  
T Nunn ◽  
W Salloum ◽  
D Pinch ◽  
S Naima
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Waiting Time ◽  
Independent Risk Factor ◽  
Patient Choice ◽  
Poor Health ◽  
Delayed Surgery ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
British Orthopaedic Association

Mortality following hip fracture surgery is high, with 7% mortality at 30 days and 18% at 120 days. This reflects the pre-existing poor health of some of those who present with such an injury. Large studies have demonstrated that delayed surgery is an independent risk factor for mortality. The British Orthopaedic Association (BOA) recommends that hip fracture surgery be undertaken within 48 hours in all those medically fit. Payment by Results (PbR) was introduced in July 2000 in the NHS Plan, linking the allocation of funds to hospitals to the activity undertaken. This was designed to 'provide a transparent, rules-based system […] which would reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions'.

Evaluation of the volume-value relationship in hip fracture care using evidence-based thresholds

2019 ◽  
Vol 30 (3) ◽  
pp. 347-353
Author(s):  
Sergio M Navarro ◽  
William C Frankel ◽  
Heather S Haeberle ◽  
Damien G Billow ◽  
Prem N Ramkumar
Keyword(s):  
Hip Fracture ◽  
Operating Characteristic ◽  
Care Delivery ◽  
High Volume ◽  
Fracture Repair ◽  
Fracture Care ◽  
Hip Fracture Surgery ◽  
Lower Volume ◽  
Relative Market Share ◽  
Fracture Surgery

Background: Studies have shown high-volume surgeons and hospitals deliver higher value care. The aims of this study were to establish meaningful thresholds defining high-volume surgeons and hospitals performing hip fracture surgery and to examine the relative market share of hip fracture cases using these surgeon and hospital strata. Methods: We performed a retrospective cohort study in a database of 103,935 patients undergoing hip fracture repair. We generated stratum-specific likelihood ratio (SSLR) models of a receiver operating characteristic (ROC) curve using length of stay (LOS) and cost value metrics. Volume thresholds predictive of decreased LOS and costs for surgeons and hospitals were identified. Results: Analysis of annual surgeon hip fracture volume produced two volume categories for LOS and cost: 0–30 (low) and 31+ (high). Analysis of LOS by annual hospital hip fracture volume produced strata at: 0–59 (low), 60–146 (medium), and 147 or more (high). Analysis of cost by annual hospital volume produced strata at: 0–125 (low) and 126+ (high). LOS and cost both decreased significantly ( p < 0.05) in progressively higher volume categories. Low-volume surgeons performed the majority of hip fracture cases, although they were performed at medium- or high-volume centres. Conclusions: This study demonstrates a direct relationship between volume and value, translating to improvement in hip fracture care delivery for both surgeons and hospitals. Higher volume hospitals while lower volume surgeons perform the majority of hip fracture cases, suggesting optimisation opportunities. However, systems-based practices at the hospital level likely drive value to a greater extent than individual surgeons.

scholarly journals Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality

2021 ◽  
Vol 2 (9) ◽  
pp. 710-720
Author(s):  
Cato Kjaervik ◽  
Jan-Erik Gjertsen ◽  
Lars B. Engeseter ◽  
Eva Stensland ◽  
Eva Dybvik ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Waiting Time ◽  
Waiting Times ◽  
Working Hours ◽  
High Volume ◽  
Mortality Rates ◽  
Hip Fracture Surgery ◽  
Low Volume ◽  
One Year ◽  
Fracture Surgery

Aims This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time. Methods Overall, 37,708 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked with data in the Norwegian Patient Registry. Hospitals treating hip fractures were characterized according to their hip fracture care. Waiting time (hours from admission to start of surgery), surgery within regular working hours, and surgery on the day of or on the day after admission, i.e. ‘expedited surgery’ were estimated. Results Mean waiting time was 22.6 hours (SD 20.7); 36,652 patients (97.2%) waited less than three days (< 72 hours), and 27,527 of the patients (73%) were operated within regular working hours (08:00 to 16:00). Expedited surgery was given to 31,675 of patients (84%), and of these, 19,985 (53%) were treated during regular working hours. Patients classified as American Society of Anesthesiologists (ASA) classes 4 and 5 were more likely to have surgery within regular working hours (odds ratio (OR) 1.59; p < 0.001), and less likely to receive expedited surgery than ASA 1 patients (OR 0.29; p < 0.001). Low-volume hospitals treated a larger proportion of patients during regular working hours than high volume hospitals (OR 1.26; p < 0.001). High-volume hospitals had less expedited surgery and significantly longer waiting times than low and intermediate-low volume hospitals. Higher ASA classes and Charlson Comorbidity Index increased waiting time. Patients not receiving expedited surgery had higher 30-day and one-year mortality rates (OR 1.19; p < 0.001) and OR 1.13; p < 0.001), respectively. Conclusion There is inequality in waiting time for hip fracture treatment in Norway. Variations in waiting time from admission to hip fracture surgery depended on both patient and hospital factors. Not receiving expedited surgery was associated with increased 30-day and one-year mortality rates. Cite this article: Bone Jt Open 2021;2(9):710–720.

scholarly journals Low Psoas Lumbar Vertebral Index Is Associated with Mortality after Hip Fracture Surgery in Elderly Patients: A Retrospective Analysis

2021 ◽  
Vol 11 (7) ◽  
pp. 673
Author(s):  
Ji-Hoon Sim ◽  
Soo-Ho Lee ◽  
Ji-Wan Kim ◽  
Won-Uk Koh ◽  
Hyung-Tae Kim ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Cox Regression ◽  
Independent Predictor ◽  
Surgical Patients ◽  
Men And Women ◽  
Cox Regression Analysis ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

The psoas-to-lumbar index (PLVI) has been reported as a simple and easy way to measure central sarcopenia. However, only few studies have evaluated the association between PLVI and survival in surgical patients. This study evaluated the association between preoperative PLVI and mortality in elderly patients who underwent hip fracture surgery. We retrospectively analyzed 615 patients who underwent hip fracture surgery between January 2014 and December 2018. The median value of each PLVI was calculated according to sex, and the patients were categorized into two groups on the basis of the median value (low PLVI group vs. high PLVI group). Cox regression analysis was performed to evaluate the risk factors for 1 year and overall mortalities. The median values of PLVI were 0.62 and 0.50 in men and women, respectively. In the Cox regression analysis, low PLVI was significantly associated with higher 1 year (hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.18–2.96, p = 0.008) and overall mortalities (HR: 1.51, 95% CI: 1.12–2.03, p = 0.006). Low PLVI was significantly associated with a higher mortality. Therefore, PLVI might be an independent predictor of mortality in elderly patients undergoing hip fracture surgery.

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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katie J. Sheehan ◽  
◽  
Boris Sobolev ◽  
Pierre Guy ◽  
Jason D. Kim ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Median Time ◽  
Supply And Demand ◽  
Fracture Repair ◽  
Clearance Time ◽  
Time To Surgery ◽  
Hip Fracture Surgery ◽  
Competing Demands ◽  
Canadian Provinces ◽  
Fracture Surgery

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.

scholarly journals Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay

2018 ◽  
Vol 9 ◽  
pp. 215145931879526 ◽  
Author(s):  
Andrew Bennett ◽  
Hsin Li ◽  
Aakash Patel ◽  
Kevin Kang ◽  
Piyush Gupta ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Retrospective Analysis ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality ◽  
Time To Surgery ◽  
Hip Fracture Surgery ◽  
Asa Classification ◽  
Fracture Surgery

Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( P = .0002) and 2.26 compared to the ASA 3 group ( P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.

The association between hospital case volume and in-hospital and one-year mortality after hip fracture surgery

2020 ◽  
Vol 102-B (10) ◽  
pp. 1384-1391
Author(s):  
Seokha Yoo ◽  
Eun Jin Jang ◽  
Junwoo Jo ◽  
Jun Gi Jo ◽  
Seungpyo Nam ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
High Volume ◽  
Case Volume ◽  
Hospital Case ◽  
Hip Fracture Surgery ◽  
Low Volume ◽  
One Year ◽  
Fracture Surgery ◽  
Very High

Aims Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Methods Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. Results Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). Conclusion Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384–1391.

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