Patient and hospital-level factors associated with time to surgery after hip  fracture in Ireland: Analysis of national audit data 2016–2020

Introduction: In hip fracture care, time to surgery (TTS) is a commonly used quality indicator associated with  patient outcomes including mortality. This study aimed to identify patient and hospital-level characteristics  associated with TTS in Ireland.  Methods: National data from the Irish Hip Fracture Database (IHFD) (2016–2020) were analysed along with  hospital-level characteristics obtained from a 2020 organisational survey. Generalised linear model regression  was used to explore the association of TTS with case-mix, surgical details, hospital-level staffing and specific  protocols recommended to expedite surgery.  Results: A total of 14,951 patients with surgically treated hip fracture from 16 hospitals were included (Mean  age= 80.6 years (SD=8.8), 70.4% female). Mean TTS was 40.9 h (SD=60.3 h). Case-mix factors associated with  longer TTS were male sex and higher American Society of Anaesthesiologists (ASA) grade. Other factors found to  be associated with longer TTS included low pre-morbid mobility, inter-hospital transfer, weekday presentation,  pre-operative medical physician assessment, intracapsular fracture type, arthroplasty surgery, general anaesthesia, consultant grade of surgeon and lower hospital-level orthopaedic surgical capacity. The oldest age-group  and pre-fracture nursing home residence were associated with shorter TTS when adjusted for other case-mix  factors. None of four explored protocols for expediting surgery were associated with TTS.  Conclusion: Patients with more comorbidity experience longer surgical delay after hip fracture in Ireland, in line  with international research. Low availability of senior orthopaedic surgeons in Ireland may be delaying hip  fracture surgery. Pathway of presentation, including via inter-hospital transfer or hospital bypass, is an important  factor that requires further exploration. Further research is required to identify successful system-level protocols  and interventions that may expedite hip fracture surgery within this setting.