Evidence map›Paper›PMID 29891474›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2018

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada.

Daniel Pincus, David Wasserstein, Bheeshma Ravi, James P Byrne, Anjie Huang, J Michael Paterson, Avery B Nathens, Hans J Kreder, Richard J Jenkinson, Walter P Wodchis

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In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed.

  1. Admission to operation delay was associated with all-cause mortality in patients with hip fractures: a propensity score-matched retrospective study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
    Article
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  3. Observational
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  7. Hip fracture predicts subsequent hip fracture: a retrospective observational study to support a call to early hip fracture prevention efforts in post-fracture patients.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022
    Observational
  8. Article
  9. Article
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  11. Strong administrative support needed to improve wait times for hip fracture.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019
    Article
  12. The association of female sex with application of evidence-based practice recommendations for perioperative care in hip fracture surgery.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019
    Observational
  13. Patient engagement in research related to accelerated surgical care and treatment for hip fracture.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018
    Article
  14. Focus on saving money lets patients and surgeons down.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Daniel PincusDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont. d.pincus@utoronto.ca.
David WassersteinDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Bheeshma RaviDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
James P ByrneDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Anjie HuangDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
J Michael PatersonDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Avery B NathensDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Hans J KrederDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Richard J JenkinsonDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.
Walter P WodchisDepartment of Surgery (Pincus, Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), University of Toronto; Institute for Clinical Evaluative Sciences (Pincus, Ravi, Paterson, Nathens, Kreder, Wodchis); Institute of Health Policy, Management and Evaluation (Pincus, Byrne, Huang, Paterson, Nathens, Kreder, Jenkinson, Wodchis), University of Toronto; Department of Surgery (Wasserstein, Ravi, Byrne, Nathens, Kreder, Jenkinson), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute-University Health Network (Wodchis), Toronto, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough a delay of 24 hours for hip fracture repair is associated with medical complications and costs, it is unknown how long patients wait for surgery for hip fracture. We describe novel methods for measuring exact urgent and emergent surgical wait times (in hours) and the factors that influence them.

methodsAdults aged 45 years and older who underwent surgery for hip fracture (the most common urgently performed procedure) in Ontario, Canada, between 2009 and 2014 were eligible. Validated data from linked health administrative databases were used. The primary outcome was the time elapsed from hospital arrival recorded in the National Ambulatory Care Reporting System until the time of surgery recorded in the Discharge Abstract Database (in hours). The influence of patient, physician and hospital factors on wait times was investigated using 3-level, hierarchical linear regression models.

resultsAmong 42 230 patients with hip fracture, the mean (SD) wait time for surgery was 38.76 (28.84) hours, and 14 174 (33.5%) patients underwent surgery within 24 hours. Variables strongly associated with delay included time for hospital transfer (adjusted increase of 26.23 h, 95% CI 25.38 to 27.01) and time for preoperative echocardiography (adjusted increase of 18.56 h, 95% CI 17.73 to 19.38). More than half of the hospitals (37 of 72, 51.4%), compared with 4.8% of surgeons and 0.2% of anesthesiologists, showed significant differences in the risk-adjusted likelihood of delayed surgery.

interpretationExact wait times for urgent and emergent surgery can be measured using Canada's administrative data. Only one-third of patients received surgery within the safe time frame (24 h). Wait times varied according to hospital and physician factors; however, hospital factors had a larger impact.

Indexed as

AgedAged, 80 and overCross-Sectional StudiesEmergency Medical ServicesEmergency Service, HospitalFemaleFracture Fixation, InternalHip FracturesHumansMaleMiddle AgedOntarioOutcome and Process Assessment, Health CareTime-to-TreatmentTreatment OutcomeWaiting Lists

Identifiers

PMID29891474
PMCPMC5995591

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.