• Victor Novack, Alan Jotkowitz, Ohad Etzion, and Avi Porath.
• HMS Medcn-BIDMC, Harvard Clinical Research Institute, 930 Commonwealth Avenue, West Boston, MA 02215, USA. victor.novack@hcri.harvard.edu
• Int J Qual Health Care. 2007 Jun 1; 19 (3): 170-6.

ObjectiveTo estimate the impact of delays in surgery for hip fracture on short- and long-term outcomes.DesignAnalysisof inpatient hospital data integrated with national health plan data and Central Bureau Statistics.SettingSeven major tertiary hospitals. Patients All consecutive elderly patients admitted with hip fracture during the years 2001-2005.Main Outcome MeasuresTime from the hospitalization to operation; one-year mortality.Main ResultStudy population comprise 4633 patients, older than 65 years. The conservative approach was chosen in 818 patients (17.7%), while 1350 patients (29.1%) waited >2 days from admission to the surgery. There was a substantial variation in median pre-operative stay among the hospitals (range 0-4 days). Patients who had surgery within 2 days had lower mortality (in-hospital, 1-month and 1-year) compared to those who waited for surgery >4 days (2.9%, 4.0%, 17.4% vs. 4.6%, 6.1%, 26.2%, respectively). A Cox proportional regression model of 1-year mortality in operated patients adjusted for background morbidity (Charlson index) showed that the length of operation delay has a gradual effect on increasing mortality (<2 days-reference group, 2-4 days-OR = 1.20, 5 days or longer, OR=1.50). The 818 (17.7%) non-operated patients suffered the highest 1-year mortality, 36.2%.ConclusionsDelays in surgery for hip fracture are associated with significant increase in short-term and 1-year mortality. Variation among the hospitals was substantial and calls for prompt quality improvement actions.

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