Australians have around 19 000 hip fractures each year, and the estimated cost to the health care system was $445 million in 2015–16. Surgery within 48 hours of initial presentation to hospital is widely accepted as a clinically meaningful indicator of best practice care. However, timely access to emergency orthopaedic hip fracture surgery is difficult in a country as large and geographically diverse as Australia; patients admitted to remote or regional hospitals that do not provide orthopaedic surgery must be transferred to larger regional centres.
In a retrospective population study, researchers evaluated the impact of pre‐surgery hospital transfer and time to surgery on 30‐day mortality for people aged 65 years or more who underwent surgical interventions for fall‐related hip fractures in NSW public hospitals during 1 January 2011 – 31 December 2018. Hospitalisation data from the NSW Admitted Patient Data Collection and deaths data from the NSW Registry of Births, Deaths and Marriages were linked to provide person‐level records. Time to surgery (in calendar days) was estimated from the date of admission for the first episode of care to the date of surgery. Comorbid conditions during the preceding year were identified with the Charlson Comorbidity Index (CCI). Multilevel multivariable logistic regression models were fitted to assess the influence of patient‐level factors (age, sex, comorbidity) and process factors (transfer status, time to surgery) on 30‐day mortality.
In this large study of 36,956 patients in NSW who underwent hip fracture repair procedures in 36 hospitals, researchers found that transfer from non‐operating to operating hospitals, after adjusting for patient and hospital characteristics, was not associated with higher 30‐day mortality, despite increasing the time between initial presentation and surgery. This is contrary to the findings of earlier, single centre studies in Australia. However, this study was the first to control for several key person‐level factors that increase the risk of death, and the findings suggest that time to surgery may be less important for health outcomes than these factors when other dimensions of care quality are equal. More research is required to understand the interplay between the effects of patient demographic characteristics, pre‐injury health status, and the quality of hip fracture care on 30‐day mortality for patients.
- Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures. The Medical Journal of Australia. 7 June 2021