Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery:A Canadian database study
| Autor: | Michael Tang, Pierre Guy, Susan Sirett, Edward J. Harvey, Katie Jane Sheehan, Lisa Kuramoto, Suzanne N Morin, Michael J. Dunbar, James P. Waddell, Boris Sobolev |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Canada Time Factors Exacerbation Databases Factual Nice Hip fracture surgery Medical Records Time-to-Treatment Clinical coder 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans 030212 general & internal medicine discharge abstracts computer.programming_language Aged Aged 80 and over 030222 orthopedics Hip fracture business.industry Hip Fractures Research Database study surgical fitness General Medicine Guideline medicine.disease medical delays 3. Good health Surgery Hospitalization hip fracture Emergency medicine time to surgery Female Diagnosis code Health Services Research business computer |
| Zdroj: | 2017, ' Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery : A Canadian database study ', BMJ Open, vol. 7, no. 10, e017869 . https://doi.org/10.1136/bmjopen-2017-017869 BMJ Open |
| Popis: | PurposeFailure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery.MethodsWe assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes.ResultsIn total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends.ConclusionAdministrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. |
| Databáze: | OpenAIRE |
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