title: The influence of procedure delay on resource use: a national study of patients with open tibial fracture.
abstract: BACKGROUND
  The purpose of this study was to (1) understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level and (2) compare length of stay and cost in patients cared for at the best- and worst-performing hospitals for delay.
  
  
  METHODS
  The authors retrospectively analyzed the 2003 to 2009 Nationwide Inpatient Sample. Adult patients with open tibial fracture were included. Hospital probability of delay in performing emergency procedures beyond the day of admission was calculated. Multilevel linear regression random-effects models were created to evaluate the relationship between the treating hospital's tendency for delay (in quartiles) and the log-transformed outcomes of length of stay and cost.
  
  
  RESULTS
  The final sample included 7029 patients from 332 hospitals. Patients treated at hospitals in the fourth (worst) quartile for delay were estimated to have 12 percent (95 percent CI, 2 to 21 percent) higher cost compared with patients treated at hospitals in the first quartile. In addition, patients treated at hospitals in the fourth quartile had an estimated 11 percent (95 percent CI, 4 to 17 percent) longer length of stay compared with patients treated at hospitals in the first quartile.
  
  
  CONCLUSIONS
  Patients with open tibial fracture treated at hospitals with more timely initiation of surgical care had lower cost and shorter length of stay than patients treated at hospitals with less timely initiation of care. Policies directed toward mitigating variation in care may reduce unnecessary waste.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Departments of Neurology, Pediatrics, and Internal Medicine, University of Michigan Health System, and the Veterans Administration Health System.
authors.forename: Erika Davis
authors.initials: ED
authors.lastname: Sears
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D004638:Emergency Treatment / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005597:Fractures, Open / Q000191:economics* / Q000601:surgery*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000191:economics* / Q000601:surgery*; D013997:Time Factors; D014481:United States