Kreindler Sara A, Siragusa Lanette, Bohm Eric, Rudnick Wendy, Metge Colleen J
From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick).
Can J Surg. 2017 Sep;60(5):349-354. doi: 10.1503/cjs.000517.
Timely access to orthopedic trauma surgery is essential for optimal outcomes. Regionalization of some types of surgery has shown positive effects on access, timeliness and outcomes. We investigated how the consolidation of orthopedic surgery in 1 Canadian health region affected patients requiring hip fracture surgery.
We retrieved administrative data on all regional emergency department visits for lower-extremity injury and all linked inpatient stays from January 2010 through March 2013, identifying 1885 hip-fracture surgeries. Statistical process control and interrupted time series analysis controlling for demographics and comorbidities were used to assess impacts on access (receipt of surgery within 48-h benchmark) and surgical outcomes (complications, in-hospital/30-d mortality, length of stay).
There was a significant increase in the proportion of patients receiving surgery within the benchmark. Complication rates did not change, but there appeared to be some decrease in mortality (significant at 6 mo). Length of stay increased at a hospital that experienced a major increase in patient volume, perhaps reflecting challenges associated with patient flow.
Regionalization appeared to improve the timeliness of surgery and may have reduced mortality. The specific features of the present consolidation (including pre-existing interhospital performance variation and the introduction of daytime slates at the referral hospital) should be considered when interpreting the findings.
及时获得骨科创伤手术对于实现最佳治疗效果至关重要。某些类型手术的区域化已显示出对可及性、及时性和治疗效果具有积极影响。我们调查了加拿大一个卫生区域内骨科手术的整合对需要髋部骨折手术的患者产生了怎样的影响。
我们检索了2010年1月至2013年3月期间该区域所有因下肢损伤前往急诊科就诊的管理数据以及所有相关的住院记录，共识别出1885例髋部骨折手术。采用统计过程控制和中断时间序列分析，并对人口统计学和合并症进行控制，以评估对可及性（在48小时基准内接受手术）和手术结果（并发症、住院/30天死亡率、住院时间）的影响。
在基准时间内接受手术的患者比例显著增加。并发症发生率没有变化，但死亡率似乎有所下降（6个月时显著）。在患者数量大幅增加的一家医院，住院时间有所延长，这可能反映了与患者流量相关的挑战。
区域化似乎改善了手术的及时性，并且可能降低了死亡率。在解释研究结果时，应考虑当前整合的具体特征（包括医院间预先存在的绩效差异以及在转诊医院引入日间手术安排）。
