Key result
High surgical admission volume is linked to ~20% higher hip fracture mortality, driven by delayed surgery.
Why the study?
Few studies have investigated the potential consequences of strained surgical resources on delayed surgery and mortality for hip fracture patients.
Does a high volume of concurrent acute surgical admissions delay surgery and increase 60-day mortality in older patients with acute hip fracture?
Cohort (n=60,072)
Yes
Does a high volume of concurrent acute surgical admissions delay surgery and increase 60-day mortality in older patients with acute hip fracture?
High volumes of concurrent acute surgical admissions are associated with delayed surgery and increased 60-day mortality in older patients with hip fractures.
High admission volumes may delay hip fracture surgery and raise mortality; leaves open whether capacity interventions improve outcomes.
Aims Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. Methods This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. Results Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). Conclusion A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264–270.
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Nilsen et al. (2021) conducted a cohort in Acute hip fracture (n=60,072). High proportion of recent surgical admissions (75th percentile) vs. Low proportion of recent surgical admissions (25th percentile) was evaluated on 60-day mortality (HR 1.2, 95% CI 1.1 to 1.4). A high volume of recent surgical admissions was associated with delayed surgery and a 20% higher 60-day mortality for hip fracture patients (HR 1.2; 95% CI 1.1 to 1.4).
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