Variation in surgical demand and time to hip fracture repair: a Canadian database study

Table 3 Time to surgery for first hip fracture by demand, overall and by the presence/absence of medical reasons for surgical delay

Overall
Demand, by clearance time^a	No. of Surgeries	Median Time to Surgery, Days (95% CI)	Unadjusted Percentage Change, % (95% CI)^b	Adjusted Percentage Change, % (95% CI)^bcd
Benchmark demand	61,090	1.5 (1.5 to 1.6)	Reference	Reference
Medium demand	71,183	1.7 (1.6 to 1.7)	8.6 (7.8 to 9.4)	5.1 (4.1 to 6.1)
High demand	17,192	1.8 (1.7 to 1.9)	17.2 (15.9 to 18.6)	12.2 (10.3 to 14.2)
Excessive demand	2487	1.9 (1.8 to 2.1)	27.0 (23.6 to 30.5)	22.0 (17.7 to 26.2)
Without a medical reason for surgical delay
Demand, by clearance time^a	No. of Surgeries	Median Time to Surgery, Days (95% CI)	Unadjusted Percentage Change, % (95% CI)^b	Adjusted Percentage Change, % (95% CI)^{b e d}
Benchmark demand	57,136	1.5 (1.4 to 1.5)	Reference	Reference
Medium demand	66,376	1.6 (1.5 to 1.7)	8.5 (7.7 to 9.3)	5.1 (4.1 to 6.1)
High demand	15,986	1.7 (1.7 to 1.8)	17.3 (15.9 to 18.6)	12.6 (10.6 to 14.5)
Excessive demand	2310	1.9 (1.8 to 2.0)	27.3 (23.8 to 30.8)	22.2 (17.8 to 26.6)
With a medical reason for surgical delay
Demand, by clearance time^a	No. of Surgeries	Median Time to Surgery, Days (95% CI)	Unadjusted Percentage Change, % (95% CI)^b	Adjusted Percentage Change, % (95% CI)^{b e d}
Benchmark demand	3954	2.2 (2.1 to 2.4)	Reference	Reference
Medium demand	4807	2.4 (2.3 to 2.5)	8.3 (4.6 to 12.0)	5.6 (2.0 to 9.3)
High demand	1206	2.5 (2.4 to 2.7)	12.4 (6.5 to 18.4)	9.1 (3.0 to 15.2)
Excessive demand	177	2.7 (2.2 to 3.1)	19.0 (4.2 to 33.7)	20.0 (1.8 to 38.1)

^aThe expected length of time for all hospitalized patients with hip fracture present on day of index patient admission to undergo surgery when hospital operates at maximum weekly service rate for the corresponding fiscal quarter. Benchmark demand (within 2-days), medium demand (within 4 days), high demand (within 6 days), and excessive demand (7 or more days)
^bPercentage change is the median time to surgery in one demand group minus the median time to surgery in the reference group, divided by the median time in the reference group, and multiplied by 100%. It is estimated by subtracting one from the exponential of the regression coefficient and multiplying the result by 100%
^cAdjusted for age, sex, prefracture health status, timing of admission, admission status, preoperative transfer history, preoperative procedures, medical reason for delay, hospital type at surgery, fracture type, procedure type, treatment era, and province
^dRandom intercepts by hospital ID and random coefficients for demand; random effects by grouping patients according to hospital ID and allowing the effect of demand to vary by the grouping structure
^e Adjusted for age, sex, prefracture health status, timing of admission, admission status, preoperative transfer history, preoperative procedures, hospital type at surgery, fracture type, procedure type, treatment era, and province

ISSN: 1472-6963