title: Determinants of surgical delay for hip fracture.
abstract: OBJECTIVE
  Recent guidelines recommend early surgical treatment of hip fractures in the elderly. The aim of the present study is to analyse the factors delaying surgical treatment of hip fractures in elderly patients by more than 2 days and to investigate whether these factors are consistent between a teaching and a community hospital.
  
  
  METHODS
  
  
  
  METHODS
  Retrospective cohort study using hospital discharge records and patients' charts.
  
  
  METHODS
  Orthopaedics and traumatology departments of a teaching hospital and a small town hospital in Northern Italy.
  
  
  METHODS
  1768 consecutive patients aged 65 years or more who underwent surgery for hip fractures between 2004 and 2007.
  
  
  METHODS
  Surgery for hip fracture.
  
  
  METHODS
  Surgery within two days from admission.
  
  
  RESULTS
  938 (53.1%) patients were operated within 2 days of admission to the hospital. Logistic regression models were used to examine potential predictors of surgery delay including gender, age, hospital, comorbidity, type of intervention (partial or total hip replacement, reduction and internal fixation), International Normalized Ratio (INR), Haemoglobin (Hb), American Society of Anaesthesiologists (ASA) score, and day of admission (categorized as Monday to Wednesday, Thursday-Friday, Saturday-Sunday). Age, type of intervention (partial or total hip replacement), INR score > 1.5 and an ASA score of 4 compared to 1-2, admission on Thursday-Friday or Saturday-Sunday and the interaction hospital × arrhythmia significantly predicted a surgery delay of more than 2 days.
  
  
  CONCLUSIONS
  Both organization and medical problems accounted for delays of surgical treatment of hip fractures. Established protocols aimed to optimize the patient flow logistics and to manage comorbidities are crucial to make hospitals more patient-centred and to improve patient outcomes.
authors.affiliation: Department of Public Health, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Fantini
authors.forename: G
authors.initials: G
authors.lastname: Fabbri
authors.forename: M
authors.initials: M
authors.lastname: Laus
authors.forename: E
authors.initials: E
authors.lastname: Carretta
authors.forename: S
authors.initials: S
authors.lastname: Mimmi
authors.forename: G
authors.initials: G
authors.lastname: Franchino
authors.forename: L
authors.initials: L
authors.lastname: Favero
authors.forename: P
authors.initials: P
authors.lastname: Rucci
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006620:Hip Fractures / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D019934:International Normalized Ratio; D007558:Italy; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors