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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 3,
361-366.
doi: 10.1302/0301-620X.87B3.15300 Copyright © 2005 by British Editorial Society of Bone and Joint Surgery The effect of hospital type and surgical delay on mortality after surgery for hip fractureI. Weller, PhD, Epidemiologist Orthopaedics Research Group; and E. K. Wai, MD, MSc, Orthopaedic SurgeonDepartment of Orthopaedics Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Avenue, Room MG 321, Toronto, Ontario Canada, M4N 3M5. S. Jaglal, PhD, Adjunct Scientist; and H. J. Kreder, MD, MPH, Adjunct Scientist Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Room G106, Toronto, Ontario Canada M4N 3M5. Correspondence should be sent to Dr. I. Weller; e-mail: iris.weller{at}sw.ca
Death during the first year after hip fracture may be influenced by the type of hospital in which patients are treated as well as the time spent awaiting surgery. We studied 57 315 hip fracture patients who were admitted to hospital in Ontario, Canada. Patients treated in teaching hospitals had a decreased risk of in-hospital mortality (odds ratio (OR) 0.89; 95% confidence interval (CI) 0.83 to 0.97) compared with those treated in urban community institutions. There was a trend toward increased mortality in rural rather than urban community hospitals. In-hospital mortality increased as the surgical delay increased (OR 1.13; 95% CI 1.10 to 1.16) for a one-day delay and higher (OR 1.60; 95% CI 1.42 to 1.80) for delays of more than two days. This relationship was strongest for patients younger than 70 years of age and with no comorbidities but was independent of hospital status. Similar relationships were seen at three months and one year after surgery. This suggests that any delay to surgery for non-medical reasons is detrimental to a patient’s outcome. This article has been cited by other articles:
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