Patient and hospital-level factors associated with time to surgery after hip fracture in Ireland: Analysis of national audit data 2016-2020

Mary E Walsh; Catherine Blake; Cathal D Walsh; Louise Brent; Jan Sorensen

doi:10.1016/j.injury.2023.04.038

Patient and hospital-level factors associated with time to surgery after hip fracture in Ireland: Analysis of national audit data 2016-2020

Injury. 2023 Apr 16:S0020-1383(23)00371-6. doi: 10.1016/j.injury.2023.04.038. Online ahead of print.

Authors

Mary E Walsh¹, Catherine Blake², Cathal D Walsh³, Louise Brent⁴, Jan Sorensen⁵

Affiliations

¹ School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland. Electronic address: m.walsh@ucd.ie.
² School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
³ Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland.
⁴ National Office of Clinical Audit, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
⁵ Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.

PMID: 37085350
DOI: 10.1016/j.injury.2023.04.038

Abstract

Introduction: In hip fracture care, time to surgery (TTS) is a commonly used quality indicator associated with patient outcomes including mortality. This study aimed to identify patient and hospital-level characteristics associated with TTS in Ireland.

Methods: National data from the Irish Hip Fracture Database (IHFD) (2016-2020) were analysed along with hospital-level characteristics obtained from a 2020 organisational survey. Generalised linear model regression was used to explore the association of TTS with case-mix, surgical details, hospital-level staffing and specific protocols recommended to expedite surgery.

Results: A total of 14,951 patients with surgically treated hip fracture from 16 hospitals were included (Mean age= 80.6 years (SD=8.8), 70.4% female). Mean TTS was 40.9 h (SD=60.3 h). Case-mix factors associated with longer TTS were male sex and higher American Society of Anaesthesiologists (ASA) grade. Other factors found to be associated with longer TTS included low pre-morbid mobility, inter-hospital transfer, weekday presentation, pre-operative medical physician assessment, intracapsular fracture type, arthroplasty surgery, general anaesthesia, consultant grade of surgeon and lower hospital-level orthopaedic surgical capacity. The oldest age-group and pre-fracture nursing home residence were associated with shorter TTS when adjusted for other case-mix factors. None of four explored protocols for expediting surgery were associated with TTS.

Conclusion: Patients with more comorbidity experience longer surgical delay after hip fracture in Ireland, in line with international research. Low availability of senior orthopaedic surgeons in Ireland may be delaying hip fracture surgery. Pathway of presentation, including via inter-hospital transfer or hospital bypass, is an important factor that requires further exploration. Further research is required to identify successful system-level protocols and interventions that may expedite hip fracture surgery within this setting.

Keywords: Femoral fracture; Hip fracture; Surgical delay; Time to surgery, system factors.