PT  - JOURNAL ARTICLE
AU  - Boris Sobolev
AU  - Pierre Guy
AU  - Katie Jane Sheehan
AU  - Lisa Kuramoto
AU  - Jason M. Sutherland
AU  - Adrian R. Levy
AU  - James A. Blair
AU  - Eric Bohm
AU  - Jason D. Kim
AU  - Edward J. Harvey
AU  - Suzanne N. Morin
AU  - Lauren Beaupre
AU  - Michael Dunbar
AU  - Susan Jaglal
AU  - James Waddell
ED  - ,
TI  - Mortality effects of timing alternatives for hip fracture surgery
AID  - 10.1503/cmaj.171512
DP  - 2018 Aug 07
TA  - Canadian Medical Association Journal
PG  - E923--E932
VI  - 190
IP  - 31
4099  - http://www.cmaj.ca/content/190/31/E923.short
4100  - http://www.cmaj.ca/content/190/31/E923.full
SO  - CMAJ2018 Aug 07; 190
AB  - BACKGROUND: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.METHODS: We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.RESULTS: Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%).INTERPRETATION: Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.