Seniors who wait longer for hip fracture surgery tend to have worse health outcomes: CIHI Report

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Most patients have surgery on the day of admission to hospital or the next day, but length of wait varies between regions

May 30, 2007 — Almost two-thirds (65%) of hip fracture patients aged 65 and older had surgery on the day they were admitted to hospital or the next day in 2005–2006, but new indicators published today by the Canadian Institute for Health Information (CIHI) show that some patients have longer waits. For example, 8% of seniors admitted to Canadian hospitals outside Quebec with hip fractures (about 1,400 patients) spent four or more days in hospital before undergoing surgery.

CIHI’s annual Health Indicators 2007 report,produced with Statistics Canada, provides over 40 measures of health and health system performance in Canada and now includes indicators on wait time for hip fracture surgery.

“For the first time, we can compare how quickly seniors who break a hip in different parts of the country undergo surgery, from eastern Newfoundland to Vancouver Island,” says Jennifer Zelmer, CIHI’s Vice President of Research and Analysis. “This is important new information, because evidence suggests that hip fracture patients who have surgery sooner tend to have better health outcomes.”

CIHI’s analysis found that longer waits for surgery were associated with higher short-term death rates. In 2005–2006, in hospitals outside of Quebec, about 17,000 surgical procedures to repair hip fractures on patients aged 65 and older were performed. Overall, about 6% of these, or about 1,000 patients, died in hospital within 30 days of admission. The mortality risk for patients who waited longer for surgery was 22% higher than for those treated on the day of admission to hospital or the next day, after accounting for other factors that affect mortality such as age and other health problems.

“Hip fractures represent a tremendous health burden for seniors. Recovery is often slow and painful, and many patients experience a loss of mobility and other health problems,” says Dr. Michael Dunbar, Associate Professor of Orthopedic Surgery at Dalhousie University.”While there are medical reasons to delay surgery for some patients, research has shown that patients who wait longer for surgery to repair a broken hip are more likely to experience complications, to have longer stays in hospital and to have poorer recovery of function.”

For example, CIHI’s report found that patients who underwent hip fracture surgery on the day they were admitted to hospital or the next day spent an average of 18.5 days in hospital aftersurgery, compared to an average of 20.5 days after surgery for those who waited longer.

Variations in wait time for hip fracture surgery

How quickly patients have hip fracture surgery varies across the country. In Prince Edward Island (78%), British Columbia (71%) and Nova Scotia (69%), patients were more likely than the overall average (65%) to have surgery on the day of admission or the next day in 2005–2006, while patients in Manitoba (53%) and Saskatchewan (56%) were less likely to do so.

CIHI’s report also lists several other factors that may affect how long a patient has to wait for surgery. Patients are less likely to have surgery on the day of admission or the next day if they have to be transferred to another hospital for care, if they are admitted to a larger community or teaching hospital, if they are admitted in the afternoon or evening or if they are admitted on a weekday.

Hip fracture hospitalization rates declining in Canada

In 2005–2006, there were approximately 28,200 hospitalizations for hip fractures across Canada (including Quebec), with the vast majority (88%) involving patients aged 65 or older. This represents 502 hip fracture hospitalizations per 100,000 seniors, down from 575 in 2000–2001, a decrease of 13% once population growth and aging are taken into account.

Across Canada, five provinces had hip fracture hospitalization rates that were above the national average (Alberta, Saskatchewan, Ontario, New Brunswick and Newfoundland and Labrador), while three provinces had lower rates (Manitoba, Quebec and Nova Scotia).

“Research has identified several factors associated with the risk of fracturing a hip, including osteoporosis, low physical activity and multiple medication use, as well as a senior’s physical surroundings,” says Greg Webster, CIHI’s Director of Research and Indicator Development. “Several studies suggest that fall-prevention strategies can be effective in reducing hip fractures among the elderly, which can be costly both for patients in terms of pain and lost mobility and for the health system.”

One in a thousand seniors break a hip during their hospital stay

Although most hip fractures occur in the community, a significant number happen in hospitals, nursing homes and long-term care facilities. CIHI’s report found that between 2003–2004 and 2005–2006, about 1 in 1,000 seniors admitted to hospital outside of Quebec and Manitoba fractured a hip during their stay, a rate that is consistent with last year’s results. This represents over 500 patients a year.

Other highlights from Health Indicators 2007

Health Indicators 2007 provides comparable data on the health of Canadians, on community and health system characteristics and on the performance of the health system for provinces and territories, as well as for the 75 largest health regions (representing 95% of Canada’s population). For the first time, this information is being released as a stand-alone report, with a special focus section on hip fracture indicators and related analysis. The following are among the significant findings from the new health indicators results:

  • Caesarean section rates vary across Canada: Across the country, 26.3% of women delivered babies by C-section in 2005–2006, but rates vary significantly between provinces: B.C. (30.4%), Ontario (27.7%) and the Atlantic provinces (28.0 to 30.1%) had rates above the national average. C-section rates in Saskatchewan (21.1%), Manitoba (21.3%) and Quebec (22.9%) were lower than the Canada average.
  • Cardiac bypass surgery is decreasing: Coronary artery bypass surgery (CABG) rates continue to decrease in Canada. There were 84 CABG hospitalizations per 100,000 population in 2005–2006 compared to 88 per 100,000 in 2004–2005, a decrease of 5% after adjustment for population growth and aging. Rates of percutaneous coronary intervention (PCI), commonly known as angioplasty, remained relatively stable over this period.
  • Ambulatory-care sensitive conditions vary: Hospitalization rates for ambulatory care sensitive conditions vary from province to province. This indicator reflects hospital admissions for conditions such as diabetes, asthma or hypertension, which can often be successfully managed in the community. While not all of these hospitalizations are avoidable, appropriate access to primary health care and chronic disease management may reduce the risk of hospitalization. An average of 389 patients per 100,000 population under 75 years of age in Canada were hospitalized for ambulatory care sensitive conditions in 2005–2006. Three provinces had rates below this average: B.C. (320 per 100,000), Ontario (352) and Quebec (377); the other provinces and the three territories had higher rates.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca