Evaluating Canada’s 48-hour hip surgery benchmark, comparing patient outcomes after different surgery wait-times

Comparing patient outcomes after different surgery wait-times.

A new Canadian Institutes of Health Research (CIHR)-funded study will identify if patients benefited from having hip fracture surgery within 48-hours of admission, the national benchmark adopted by Canada’s health ministers in 2005. The study, led by VCHRI researchers Dr. Boris Sobolev and Dr. Pierre Guy, seeks to provide evidence for the changes in hospital care that are required to prioritize access to the procedure.

“Setting up the 48-hour benchmark for hip fracture surgery led to resource allocation decisions in hospitals,” says Dr. Sobolev, health services researcher at the Centre for Clinical Epidemiology and Evaluation (C2E2) and professor at the UBC School of Population and Public Health. “This prompted our research team to ask: ‘What subgroups of patients will really benefit from accelerating their surgery through the 48-hour commitment?’

While almost two-thirds of hip fracture patients in Canada receive surgical treatment on the day of admission or the next day, data from the Canadian Institute for Health Information (CIHI) indicates that the timing of surgery varies widely across the country. In their successful application for CIHR funds, the researchers argued that examining these variations in time to surgery and case mix across Canadian surgical services offers sufficient statistical power to detect true differences in outcomes among patients with various wait times.

Nationwide research interest on expedited hip surgery

The proposed pan-Canadian collaboration involves every hospital that provides hip-fracture surgery in Canada. Researchers will be working directly with CIHI for data acquisition and analysis.

“This is truly a pan-Canadian study in terms of understanding how delivery of hip fracture surgery is organized – what happens in Nova Scotia can be quite different from what happens in Ontario, for example,” says Dr. Sobolev. “The leadership shown by B.C., and Dr. Guy in particular, got us to this point with everybody on board and eager for this knowledge.”

The study will describe hip fracture surgery times for hospitals across the entire country using a standardized methodology for defining care episodes – i.e. when the clock for the 48-hour period started ticking. Researchers expect the study will help test the effect of policy and assist clinical decision-making and prioritization.  Results will identify types of patients who would benefit from accelerated access to hip fracture surgery in terms of fewer complications and deaths.

“Hip fractures are a significant stressor particularly for seniors, who are often frail, with up to 30% of individuals not surviving the first year post-injury,” explains Dr. Guy, co-leader of the hip fracture research group at the Centre for Hip Health and Mobility and associate professor at the Department of Orthopaedics at UBC.

Hip fracture is a common reason for admission to hospital in the elderly with approximately 30,000 individuals requiring treatment annually in Canada (and 3,900 in B.C.)1. Mortality during hospital admission is slightly under 10%2

“Not only is the event devastating to the individual patient, it also impacts families and other supports,” adds Dr. Guy, orthopaedic trauma surgeon at Vancouver General Hospital. “Any improvement in surgical outcomes in terms of mobility, returning to normal everyday activities, and reducing risk of death would be hugely beneficial for this vulnerable and growing population.”