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Why prioritizing hip fracture surgery could save thousands of lives each year

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4 Comments
  • Jean Miller says:

    I am an osteoarthritis patient who does research with others with OA and those patients would whole-heartedly agree that hip surgery needs to happen sooner rather than later. However this not a new problem. In the late 1980s my elderly mother died of pneumonia after hip surgery. She waited a long time for her surgery and became dehydrated and confused before she finally got to the OR. She developed a post-op wound infection as well as pneumonia. Prior to her hip fracture she was physically and mentally in good health. I wrote a letter to the hospital administrator and spoke to the unit staff about the fact she was kept waiting too long for a woman her age. While they shared by concern it’s taking a long time for the system to put priority on hip fractures in older people. While I commend the work the Bone and Joint Health Strategic Clinical network has done and continues to do, as a citizen it is discouraging to see this situatuion that impacts well-being and tax dollars has not been resolved.

  • Lesley Barron says:

    So there are a few issues here. Firstly, we are dealing with an EMERGENT condition, not one that can be planned for and this creates a lot of complexity. If I (as a general surgeon) am trying to get a patient with a perforated appendix to the operating room, with at the same time, a patient of a orthopedic colleague getting close to the 6 (or 48) hour mark post hip fracture, who should go first? This article implies the hip fracture and it is not nearly so simple a decision in busy after hours operating rooms, with many competing surgical specialties jostling for time for their patients’ surgeries. In a publicly funded system, when one problem gets attention and funding, often to the detriment of patients with other problems that administration is not focused on. Operating room time is wildly expensive- who is going to pay for the extra staffing (hint big $$$) required if this becomes mandated? Would you want your hip fracture surgery done at 2 am by an exhausted surgeon to get under the 6 (or 48) hour mark, or would you prefer it be done at 8 am by a surgeon with a full night’s sleep? It really bothers me to see the statement “this type of surgery just has to get priority”. All urgent cases, ie gangrenous gallbladder, kidney transplants, etc all deserve our attention. A fair system to prioritize all after hours cases is needed. Orthopedics often get access to trauma time for these type of cases (elective time scheduled to be filled on a semi-urgent basis with fractures), which is a good solution. But if 6 hours is mandated, there will be fireworks in operating rooms across the province (or country). I like the idea that we should just do everything faster, but it would be unfair to rob Peter to pay Paul, which seems likely to happen in our financially stretched system.

  • Dan Lichtman says:

    What about the availability and supply of trained orthopedic surgeons. Does that not affect the timeliness and waiting periods. I believe that on a/capita basis the US has about 35% more surgeons.
    Also OR time, is that not a variable as well?

  • Chris Carruthers says:

    Hip fractures should be aggressively treated. At least within 48 hours and maybe even less if the evidence is there. Key is to set metrics and hold administrators and physicians accountable to meet these metrics. If can’t achieve the metrics finds others who can.

Authors

Vanessa Milne

Contributor

Vanessa is a freelance health journalist and a form staff writer with Healthy Debate

Joshua Tepper

Contributor

Joshua Tepper is a family physician and the President and Chief Executive Officer of North York General Hospital. He is also a member of the Healthy Debate editorial board.

Michael Nolan

Contributor

Michael Nolan has served Canadians through many facets of Paramedic Services.  He is currently the Director and Chief of the Paramedic Service for the County of Renfrew and strategic advisor to Healthy Debate

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