Canadian Collaborative Study of Hip Fractures

The Canadian Collaborative Study of Hip Fractures compares health outcomes among patients exposed to various wait times before hip fracture surgery. The study tests whether preoperative deaths were more frequent among patients 65 years of age or older who remained untreated for non-medical reasons after admission for hip fracture. The study also tests whether postoperative complications and ensuing in-hospital deaths were less frequent when surgery was performed early after admission.
History
Led by health services researcher Boris Sobolev and orthopedic trauma surgeon Pierre Guy, a group of investigators across Canada was awarded a Canadian Institute for Health Research grant to examine if patients benefited from having hip fracture surgery within 48-hours of admission, the national benchmark adopted by Canada’s health ministers in 2005. The study seeks to provide evidence for the changes in hospital care that are required to prioritize access to hip fracture surgery and to enable policymakers to identify which patients benefit most from accelerated access to the procedure.
The significance of this research arises from the opportunity to supplement existing knowledge about the benefits of expeditious hip fracture surgery with evidence from real-life care delivered to a large number of patients across the entire country. The study aims to improve understanding of the pathways linking waits and health outcomes through a comparison of two types of in-hospital deaths, those occurring before surgery and those occurring after surgical complications. Finally the study will identify groups of patients who would benefit from accelerated access to the procedure in terms of fewer complications and deaths.
Nationwide collaboration
The collaboration involves examination of records from every hospital that provides hip-fracture surgery in Canada. “This is truly a pan-Canadian study in terms of understanding how delivery of hip fracture surgery is organized - what happens in Nova Scotia can be quite different from what happens in Ontario, for example,” says Dr. Sobolev.
The study will describe hip fracture surgery times for hospitals across the entire country using a standardized methodology for defining care episodes, i.e., when the clock for the 48-hour period started ticking. Researchers argued that examining variations in time to surgery and case mix across Canadian surgical services offers sufficient statistical power to detect true differences in outcomes among patients with various wait times.
A Health Services Research agenda for hip fracture care
Burden of Hip Fracture
For individuals
A leading cause of morbidity and loss of function, hip fracture is generally considered to be the most devastating outcome of osteoporosis. A hip fracture results in severe health problems which in turn can lead to death. These include problems that can occur after surgery (such as pulmonary embolism, infection, and heart failure).
Those who survive are confronted with major disability. Hip fracture patients may not regain their pre-fracture functional level. They may be unable to walk independently, or spend only limited time on their feet, may have difficulty with activities of daily living, be restricted in other activities such as driving or grocery shopping, will become institutionalized, need a nursing home. Depression, anxiety, and depressed mood are common after hip fracture.
Population health issue
* 148 in 100,000 each year
* 27,000 hospitalizations
* 40% unable to walk
* 25% to long-term care
* 10% will re-fracture
* 2-fold excess mortality
* Mortality during hospital admission is slightly under 10%.
Society
Any improvement in surgical outcomes in terms of mobility, returning to normal everyday activities, and reducing risk of death would be beneficial for this vulnerable and growing population.
Knowledge gaps in hip fracture care
Clinical care guidelines
Vision
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