title: Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority.
abstract: BACKGROUND
  Existing literature demonstrating the negative impact of delayed hip fracture surgery on mortality consists largely of observational studies prone to selection bias and may overestimate the negative effects of delay. We conducted an intervention study to assess initiatives aimed at meeting a 48-hour benchmark for hip fracture surgery to determine if the intervention achieved a reduction in time to surgery, and if a general reduction in time to surgery improved mortality and length of stay.
  
  
  METHODS
  We compared time to surgery, length of stay and mortality between pre- and postintervention patients with a hip fracture using the Kaplan-Meier estimator and Cox proportional hazards model adjusting for age, sex, comorbidities, type of surgery and year.
  
  
  RESULTS
  We included 3525 pre- and 3007 postintervention patients aged 50 years or older. The proportion of patients receiving surgery within the benchmark increased from 66.8% to 84.6%, median length of stay decreased from 13.5 to 9.7 days, and crude in-hospital mortality decreased from 9.6% to 6.8% (all p < 0.001). Adjusted analyses revealed reduced mortality in hospital (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.57-0.81) and at 1 year (HR 0.87, 95%CI 0.79-0.96). Independent of the intervention period, having surgery within 48 hours demonstrated decreased adjusted risk of death in hospital (HR 0.51, 95%CI 0.41-0.63) and at 1 year postsurgery (HR 0.72, 95% CI 0.64-0.80).
  
  
  CONCLUSIONS
  Coordinated, region-wide efforts to improve timeliness of hip fracture surgery can successfully reduce time to surgery and appears to reduce length of stay and adjusted mortality in hospital and at 1 year.
authors.affiliation: From the Centre For Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Wittmeier, Lix); the Concordia Hip and Knee Institute, Winnipeg Regional Health RESEARCH Can J Surg, Vol. 58, No. 4, August 2015 263 Authority (Bohm, Loucks); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Oppenheimer); the Department of Pediatrics and Child Health, University of Manitoba (Wittmeier); and the Department of Community Health Sciences, University of Manitoba (Bohm, Lix), Winnipeg, Man.
authors.forename: Eric
authors.initials: E
authors.lastname: Bohm
authors.affiliation: From the Centre For Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Wittmeier, Lix); the Concordia Hip and Knee Institute, Winnipeg Regional Health RESEARCH Can J Surg, Vol. 58, No. 4, August 2015 263 Authority (Bohm, Loucks); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Oppenheimer); the Department of Pediatrics and Child Health, University of Manitoba (Wittmeier); and the Department of Community Health Sciences, University of Manitoba (Bohm, Lix), Winnipeg, Man.
authors.forename: Lynda
authors.initials: L
authors.lastname: Loucks
authors.affiliation: From the Centre For Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Wittmeier, Lix); the Concordia Hip and Knee Institute, Winnipeg Regional Health RESEARCH Can J Surg, Vol. 58, No. 4, August 2015 263 Authority (Bohm, Loucks); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Oppenheimer); the Department of Pediatrics and Child Health, University of Manitoba (Wittmeier); and the Department of Community Health Sciences, University of Manitoba (Bohm, Lix), Winnipeg, Man.
authors.forename: Kristy
authors.initials: K
authors.lastname: Wittmeier
authors.affiliation: From the Centre For Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Wittmeier, Lix); the Concordia Hip and Knee Institute, Winnipeg Regional Health RESEARCH Can J Surg, Vol. 58, No. 4, August 2015 263 Authority (Bohm, Loucks); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Oppenheimer); the Department of Pediatrics and Child Health, University of Manitoba (Wittmeier); and the Department of Community Health Sciences, University of Manitoba (Bohm, Lix), Winnipeg, Man.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: From the Centre For Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Wittmeier, Lix); the Concordia Hip and Knee Institute, Winnipeg Regional Health RESEARCH Can J Surg, Vol. 58, No. 4, August 2015 263 Authority (Bohm, Loucks); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority (Bohm, Oppenheimer); the Department of Pediatrics and Child Health, University of Manitoba (Wittmeier); and the Department of Community Health Sciences, University of Manitoba (Bohm, Lix), Winnipeg, Man.
authors.forename: Luis
authors.initials: L
authors.lastname: Oppenheimer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D013997:Time Factors