After hours surgery and mortality: the potential role of acute care surgery models as a factor accounting for results/Response to "After hours surgery and mortality: the potential role of acute care surgery models as a factor accounting for results"

Academic and large community hospitals are more likely than smaller centres to have daytime orthopedic trauma rooms, emergency operating rooms and available, dedicated surgical personnel. In centres without daytime emergency operating rooms, the general trend is for emergency cases that can wait (su...

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Bibliographic Details
Published inCanadian Medical Association journal (CMAJ) Vol. 189; no. 5; p. E219
Main Authors Lardner, David R, Brauer, Carmen A, MacRobie, Ali, Sheehan, Katie J, Sobolev, Boris, Guy, Pierre
Format Journal Article
LanguageEnglish
Published Ottawa CMA Impact, Inc 06.02.2017
Subjects
Accounting
Children & youth
Collaboration
Colleges & universities
Fractures
Hip joint
Hospitals
Mortality
Surgery
Trauma
Canada
Calgary Alberta Canada
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Summary:Academic and large community hospitals are more likely than smaller centres to have daytime orthopedic trauma rooms, emergency operating rooms and available, dedicated surgical personnel. In centres without daytime emergency operating rooms, the general trend is for emergency cases that can wait (such as hip fracture) to do so until after elective procedures are completed and only then to proceed, which results in potential delays in care, and operations occurring at a riskier time.3 The Canadian Collaborative Study on Hip Fractures will explore the effect of after-hours admission time, procedure volume and bed occupancy on risk of death after hip fracture.7 Further, the British Columbia Hip Fracture Redesign Project is collecting prospective data on procedure time to determine the effect of after-hours procedures on outcomes.8 We hope these analyses will shed light on the mechanism underlying our reported association between treatment setting and death. At that time, we may begin to implement and evaluate interventions (such as dedicated daytime orthopaedic trauma rooms) to combat the underlying mechanisms, and hopefully, improve outcomes at all treatment settings for these vulnerable patients. 1. Lardner DR, Brauer CA, Harrop AR, et al. After hours surgery and mortality: the potential role of acute care surgery models as a factor accounting for results [letter]. CMAJ 2017;189:E219.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.732681