title: Timing of Hip Fracture Surgery and 30-Day Outcomes.
abstract: The goal of this study was to determine the proportion of patients admitted with a hip fracture to participating American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) hospitals who were treated within the United Kingdom's National Institute for Health and Care Excellence (NICE) time-to-hip-fracture-surgery benchmark. The secondary goals were to identify factors associated with missing the benchmark and to determine whether the benchmark was associated with improved 30-day patient outcomes. Patients aged 60 years or older who underwent hip fracture surgery between 2005 and 2013 were identified from the ACS-NSQIP database. Of the 26,066 patients who met the enrollment criteria, 71.4% were treated within the NICE benchmark. Many variables, including sex, race, procedure type, and hip fracture diagnosis, were statistically significant predictors of missing the benchmark (P<.001). Meeting the NICE benchmark was not associated with reductions in major complications (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.83-1.05; P=.234); however, it was associated with reductions in 30-day mortality (OR, 0.88; 95% CI, 0.78-0.99; P=.028), minor complications (OR, 0.92; 95% CI, 0.84-0.995; P=.038), and postoperative length of stay (beta=-0.77; P<.001). Current practice at participating ACS-NSQIP hospitals is compatible with the NICE time-to-surgery benchmark. However, the findings highlight the importance of further prospective investigation to monitor the effect of early-treatment benchmarks on 30-day patient outcomes. [Orthopedics. 2016; 39(6):361-368.].
authors.forename: Michael E
authors.initials: ME
authors.lastname: Neufeld
authors.forename: Nathan N
authors.initials: NN
authors.lastname: O'Hara
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Zhai
authors.forename: Henry M
authors.initials: HM
authors.lastname: Broekhuyse
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Lefaivre
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Abzug
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D058996:Quality Improvement; D013997:Time Factors; D061665:Time-to-Treatment; D006113:United Kingdom