25,000 seniors suffer broken hips: Study

But quicker the surgery, better the outcome, report suggests

Canadian Press
Almost two-thirds of seniors who suffer a broken hip go under the knife within a day or two, and they tend to have better outcomes than those who wait longer for an operation, said a report released today.

Overall, the study by the Canadian Institute for Health Information found that nearly 25,000 seniors were admitted to hospital in Canada in 2005-2006 with a broken hip. Hospitalizations for hip fractures were down 13 per cent from five years earlier.

But the report found that eight per cent of seniors admitted to hospitals outside Quebec with hip fractures spent four or more days in hospital before having surgery.

Those who had to wait longer than the next day for surgery were 22 per cent more likely to die in hospital within 30 days of admission.

"We find that there is a group that we could perhaps do a better job on," said Dr. Michael Dunbar, an orthopedic surgeon in Halifax who routinely sees elderly patients showing up in hospital in ``significant amounts of pain" after a fall.

"We've identified some low-hanging fruit, a group that is waiting and subsequently is not having as good an outcome, particularly with respect to mortality. So it's an area where we could do better."

Numerous factors can contribute to delays.

Dunbar said they can occur because a patient has to be taken off blood-thinners before surgery, or may require a cardiac assessment first.

Jennifer Zelmer, vice-president of research and analysis at CIHI, said the statistics were adjusted for these "patient factors," and the report revealed a number of other concerns related to wait times.

"If you were transferred from one hospital to another, or if you're admitted to a larger hospital, or an afternoon or evening admit, or an admission on a weekday as opposed to a weekend, those patients were more likely to have their surgery later than others," said Zelmer, one of the authors of the report.

The fact that surgery occurs more quickly when a person is admitted on a weekend might come as a surprise, but Zelmer said it has to do with the fact that someone is specifically on call on the weekend to handle trauma cases and can help a patient immediately.

"Whereas on a weekday, they may be in the middle of a hip replacement, for example, or a scheduled surgery," she said.

Dunbar agreed, noting that elective surgery isn't normally scheduled on weekends, so surgeons can start working on emergency cases such as fractured hips first thing in the morning.

Broken hips are dealt with more quickly in small hospitals, the report found.

"Seventy-four per cent, for example, got same day or next day surgery if they were admitted to a small hospital," Zelmer said.

The number was 67 per cent for a medium or large community hospital, and 57 per cent for teaching hospitals.

As for regional variations, those in Prince Edward Island, British Columbia and Nova Scotia were more likely to have surgery quickly, while patients in Manitoba and Saskatchewan were behind the national average.

Health Minister Tony Clement noted that it's the first time CIHI has measured wait times for hip fracture surgery.

"So before we didn't have a benchmark for this kind of surgery," he said.

"We didn't have a specific target. But we can use this baseline information to measure how better or worse we do in the years ahead."

The higher death rate among those who wait longer for surgery does not have have to do with problems in setting the bones, said Dunbar, but other factors.

"Because you're immobilized, you're lying in bed, you can't move, you tend to get more urinary tract infections, you get more pneumonia because you can't get up and clear your lungs, you get pressure sores, and you get blood clots," he said.

Dunbar pointed to the decline in the overall number of hip fractures – adjusted for population aging and population growth – as a positive thing.

"What that says to me is our colleagues who have been working on prevention strategies like treating osteoporosis, identifying people at risk, working on fall prevention strategies, etc., have been effective in that they're reducing the incidence of hip fractures," he said

osteoporosis prevention