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Indicator Metadata

NameHip Fracture Surgery Within 48 Hours
Short/Other Names

Not applicable

Description

Proportion having surgery within 48 hours:

The risk-adjusted proportion of hip fractures that were surgically treated within 48 hours of a patient's initial admission to an acute care hospital, among patients age 18 and older.

For further details, please see the General Methodology Notes.

Interpretation

Higher proportions are desirable.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility, Neighbourhood Income Quintile

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameHip Fracture Surgery Within 48 Hours
Short/Other Names

Not applicable

Indicator Description and Calculation
Description

Proportion having surgery within 48 hours:

The risk-adjusted proportion of hip fractures that were surgically treated within 48 hours of a patient's initial admission to an acute care hospital, among patients age 18 and older.

For further details, please see the General Methodology Notes.

Calculation: Description

Risk-adjusted rate = Observed number of procedures performed within 48 hours ÷ Expected number of procedures performed within 48 hours × Canadian proportion of surgeries performed within 48 hours

Unit of Analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:

a) An acute care hospitalization or a same-day surgery visit occurs less than 7 hours after discharge from the previous acute care hospitalization or same-day surgery visit, regardless of whether the transfer is coded;

b) An acute care hospitalization or same-day surgery visit occurs between 7 and 12 hours after discharge from the previous acute care hospitalization or same-day surgery visit, and at least one of the hospitalizations or visits has coded the transfer.

Wait time is calculated from the episode start date/time (admission date/time of first acute hospitalization of the episode of care) to the procedure date/time of the hip fracture surgery.

Notes
– For public reporting: Regional and provincial/territorial results are calculated by place of residence; facility results are calculated by place of service.
– For facility-level reporting: For episodes of care that involved transfers, the total wait time is attributed to the hospital where the surgery was performed.

Calculation: Geographic Assignment

Place of residence or service

Calculation: Type of Measurement

Percentage or proportion

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
The number of hip fracture episodes among patients age 18 and older that were surgically treated in an acute care hospital
Inclusions:
1. a. Hip fracture ICD-10-CA codes S72.0, S72.1 or S72.2 as most responsible diagnosis (MRDx), but not also as a diagnosis type (2); or

b. Where another diagnosis is coded as MRDx and also a type (2), and a diagnosis of hip fracture is coded as a diagnosis type (1) or (W), (X), (Y) but not also as a diagnosis type (2); or

c. Where convalescence or rehabilitation ICD-10-CA codes Z50.1, Z50.8, Z50.9, Z54.0, Z54.4, Z54.7, Z54.8 or Z54.9 are coded as MRDx and hip fracture is coded as diagnosis type (1) or (W), (X), (Y) but not also as a diagnosis type (2).

Note: If hip fracture surgery is not performed during the first (initial) hospitalization of the episode of care, criterion 1 (a, b or c above) must be met on both the initial and surgical record if transfer occurred.

2. Criterion 1 (a, b, c) along with a relevant CCI procedure code*:

a. 1.VA.74.^^–Fixation, hip joint

b. 1.VA 53.^^–Implantation of internal device, hip joint

c. 1.VC.74.^^–Fixation, femur

d. 1.SQ.53.^^–Implantation of internal device, pelvis

3. Age at admission: 18 years and older

4. Sex recorded as male or female

5. Admission to an acute care institution (Facility Type Code = 1)

6. Admission category recorded as emergent/urgent (Admission Category Code = U)

Notes
*Code may be recorded in any position.
Procedures coded as out of hospital and abandoned after onset (status attribute = A or OOH indicator flag = Y) are excluded.
Exclusions:
1. Records with an invalid health card number

2. Records with an invalid code for province issuing health card number

3. Cadaveric donor or stillbirth records (Admission Category Code = R or S)

4. Records with an invalid admission date or time

5. Records with an invalid discharge date or time

6. Records with an invalid procedure date or time

Numerator

Description:
A subset of the denominator and represents the number of hip fracture episodes that were surgically treated within 48 hours of initial admission to an acute care hospital

Background, Interpretation and Benchmarks
Rationale

Operative delay in older patients with hip fracture is associated with a higher risk of post-operative complications and mortality.

Wait time for surgery following hip fracture provides a measure of access to care. The wait time may be influenced by comorbid conditions, hospital transfers and practice differences related to certain types of medications, like blood thinners. However, longer waits may indicate lack of resources, physician unavailability and/or other issues related to access to care.

Interpretation

Higher proportions are desirable.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

A benchmark of hip fracture fixation within 48 hours was set by federal, provincial and territorial governments in December 2005.

References

Bergeron E, Lavoie A, Moore L, et al. Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma Acute Care Surg 2006;60(4):753-757.

Canadian Institute for Health Information. Health Indicators 2007. Ottawa, ON: CIHI; 2007

Canadian Institute for Health Information. Waiting for Heath Care in Canada: What We Know and What We Don't Know. Ottawa, ON: CIHI; 2006.

Health Canada. Final Report of the Federal Advisor on Wait Times. Ottawa, ON: Health Canada; 2006.

Ministry of Health and Long-Term Care. First Common Benchmarks Will Allow Canadians to Measure Progress in Reducing Wait Times (press release). Toronto, ON: MOHLTC; December 12, 2005. Accessed from http://news.ontario.ca/archive/en/2005/12/12/First-ever-common-benchmarks-will-allow-Canadians-to-measure-progress-in-reducin.html.

Vidal EL, Moreira-Filho DC, Coeli CM, Camargo KR Jr, Fukushima FB, Blais R. Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality? Osteoporos Int 2009;20(5):723-729

Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 2005;87(3):361-366.

Availability of Data Sources and Results
Data Sources

DAD, NACRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2012
Last Available Year:
2016

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility, Neighbourhood Income Quintile

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

A person can have more than one hip fracture and repair in the reference period; therefore, a person can be included in the indicator more than once.

Due to differences in methodology, this indicator may differ from similar indicators developed and reported by jurisdictions.

This indicator is not calculated for Quebec and therefore pan-Canadian comparison is not possible.

Trending Issues

Not applicable

Comments

Indicator results are also available in
–The Health Indicators e-Publication (at regional, provincial/territorial and national levels, calculated by place of residence), starting from 2012–2013 (http://www.cihi.ca/hirpt/?language=en)

–Your Health System: Insight (https://www.cihi.ca/en/applications), updated monthly starting from 2012–2013 (results are available by both place of residence and place of service)