title: Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair.
abstract: OBJECTIVE
  To quantify the interval between injury and hospitalization in older hip fracture patients, to quantify the time from hospital arrival to surgical repair of hip fracture, and to describe factors contributing to extended intervals between injury, hospitalization, and surgical repair of hip fracture.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four hospitals in the New York City metropolitan area.
  
  
  METHODS
  Consecutive patients aged 50 and older admitted with diagnosis of hip fracture to these four hospitals between August 1997 and August 1998.
  
  
  METHODS
  Time of injury, time of arrival to the emergency room, and time of surgery were recorded and used to calculate intervals between injury and hospital arrival and between hospital arrival and surgical repair.
  
  
  RESULTS
  Of the 571 patients enrolled, 99 (17%) arrived at the hospital more than 24 hours after injury. After hospital arrival, 17 (3%) patients did not have surgery, 166 (29%) had surgery within 24 hours of arrival, and 388 (68.0%) had surgery more than 24 hours after arrival (median 41 hours, range 25-584). For those patients who had surgery after 24 hours, 163 (29.4%) had surgery 25 to 36 hours after hospital arrival, 102 (18.4%) had surgery 37 to 48 hours after arrival, and 123 (22.2%) had surgery more than 48 hours after arrival. The primary reasons for delaying surgery more than 24 hours after hospital arrival were waiting for routine medical clearance (52%) and unavailability of the operating suite or surgeon (29%). Stabilization of associated medical conditions resulted in the lengthiest periods of delay.
  
  
  CONCLUSIONS
  A wait time of more than 24 hours from hospitalization to surgical repair of hip fracture in older patients is common. Some of this delay time is patient related and some occurs because of systems factors and may be avoidable. The extent to which surgical timing affects survival and functional recovery needs more detailed examination.
authors.affiliation: Mount Sinai School of Medicine, New York, New York 10029, USA. gretchen.orosz@msnyuhealth.org
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Orosz
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.forename: Kenneth
authors.initials: K
authors.lastname: Koval
authors.forename: Marvin
authors.initials: M
authors.lastname: Gilbert
authors.forename: Arthur
authors.initials: A
authors.lastname: Aufses
authors.forename: Elton
authors.initials: E
authors.lastname: Straus
authors.forename: Ellen
authors.initials: E
authors.lastname: Vespe
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors