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. 2017 Aug 21;7(8):e016939.
doi: 10.1136/bmjopen-2017-016939.

Patient and system factors of time to surgery after hip fracture: a scoping review

Katie J Sheehan  1 , Boris Sobolev  2 , Yuri F Villán Villán  3 , Pierre Guy  4
Affiliations

Patient and system factors of time to surgery after hip fracture: a scoping review

Katie J Sheehan et al. BMJ Open. .

Abstract

Objectives: It is disputed whether the time a patient waits for surgery after hip fracture increases the risk of in-hospital death. This uncertainty matters as access to surgery following hip fracture may be underprioritised due to a lack of definitive evidence. Uncertainty in the available evidence may be due to differences in characteristics of patients, their injury and their care. We summarised the literature on patients and system factors associated with time to surgery, and collated proposed mechanisms for the associations.

Methods: We used the framework developed by Arksey and O'Malley and Levac et al for synthesis of factors and mechanisms of time to surgery after hip fracture in adults aged >50 years, published in English, between 1 January 2000 and 28 February 2017, and indexed in MEDLINE, EMBASE, CINAHL or Ageline. Proposed mechanisms for reported associations were extracted from discussion sections.

Results: We summarised evidence from 26 articles that reported on 24 patient and system factors of time to surgery post hip fracture. In total, 16 factors were reported by only one article. For 16 factors we found proposed mechanisms for their association with time to surgery which included surgical readiness, available resources, prioritisation and out-of-hours admission.

Conclusions: We identified patient and system factors associated with time to surgery after hip fracture. This new knowledge will inform evaluation of the putative timing-death association. Future interventions should be designed to influence factors with modifiable mechanisms for delay.

Keywords: Scoping review; hip fracture; patient factors; system factors; time to surgery.

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Conflict of interest statement

Competing interests: PG has received grants from the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation and the British Columbia Specialists Services Committee for work around hip fracture care not related to this manuscript. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopedics (as a product development consultant). He is a board member and shareholder of Traumis Surgical Systems Inc. and a board member of the Canadian Orthopedic Foundation. He also serves on the speakers’ bureaus of AO Trauma North America and Stryker Canada. KJS, BS and YFVV declare they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the literature retrieval, review, exclusion and selection.
Figure 2
Figure 2
Mechanisms proposed for patient and system factors in reviewed articles. Black node indicates the outcome. Square box indicates a measurable mediator. SES, socioeconomic status.
Figure 3
Figure 3
Example of hip fracture care process map, linked to patient and system factors associated with timing of surgery. Circles represent non-care events, white squares represent care processes, and diamond represents care diagnosis. Grey squares represent patient and system factors associated with timing of surgery.
See this image and copyright information in PMC

References

    1. Sobolev B, Guy P, Sheehan KJ, et al. Time trends in hospital stay after hip fracture in Canada, 2004-2012: database study. Arch Osteoporos 2016;11:13 10.1007/s11657-016-0264-5 - DOI - PubMed
    1. Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 2010;182:1609–16. 10.1503/cmaj.092220 - DOI - PMC - PubMed
    1. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291:1738–43. 10.1001/jama.291.14.1738 - DOI - PMC - PubMed
    1. Canadian Institute for Health Information. Health Indicators. Ottawa, ON: CIHI, 2007. 2007.
    1. National Office of Clinical Audit. Irish Hip Fracture Database National Report. 2013. https://www.noca.ie/wp-content/uploads/2015/11/IHFD-National-Report-2014... (accessed 29 Sep 2016).

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