Ontario patients in need of urgent hip surgery are dealing with long wait times that could threaten their health, a new study finds.
The report, published in the Canadian Medical Association Journal (CMAJ), examined wait times for hip fracture surgery in Ontario between 2009 and 2014 using a sample of more than 42,000 adults.
The results showed that the average wait time for surgery was nearly 39 hours – much longer than the recommended "safe time frame" of 24 hours. Of the 42,000 patients sampled, just 14,000 underwent surgery within 24 hours.
There were a number of factors behind the lengthy delay in surgery, but researchers found the most common to be time taken for hospital transfers and pre-operative echocardiograms. Transferring patients for surgery was associated with a delay of more than one day, the study found, and preoperative consultations – including echocardiography – added on an extra 6 to 18 hours to a patient’s wait time.
The findings also showed that patients who arrived at the ER overnight seldom received surgery during this time.
While much of the delay can be linked to necessary pre-operation protocol, the lengthy wait times still come at a price: Previous research from the University of Toronto and the University Health Network found that adults who waited longer than 24 hours for hip fracture surgery had a higher risk-adjusted chance of dying within 30 days.
"The health risks are mainly related to the time waiting bedridden prior to surgery, because you can’t get up with a fractured hip," Dr. Daniel Pincus, author of the study and resident in orthopedics at Sunnybrook Hospital, told CTV News Channel in a video call on Monday.
"So patients, if they’re waiting for days, they’re at increased risks for blood clots, they’re at increased risks for heart attack, and early mortality. But above all of those things, it’s very uncomfortable, because it’s the biggest bone in your body. It sets off a huge inflammatory reaction, and it’s extremely painful."
Pincus added that the study’s findings showed urgent hip surgery wait time mostly depends on which hospital the patient is taken to, indicating that efforts to improve wait times in Ontario should centre on bettering performance at the hospital level.
"We’ve done a lot of work in America and Canada trying to improve wait times, but they’ve historically focused on elective procedures, waiting for specialist consultation, and so forth, and urgent surgical wait times, like the ones we’ve studied in this paper, have traditionally been forgotten," Pincus said.
"We are doing much better than what we used to be, so wait times are coming down, but we feel as though we can still make great improvements. . . . We do need more resources for urgent surgical procedures. It’s just something that’s necessary."
Hip surgery is also the most common urgently performed procedure in Ontario, according to the CMAJ, with more than 30,000 procedures performed each year.
