Hip Fractures, Anesthesia, Death
Conditions
Keywords
hip fracture, geriatric, epidemiology, practice variation, anesthesia
Brief summary
The investigators will use health administrative data to examine the variation of anesthesia type for hip fracture surgery, as well as sources of variation and predictors of variation.
Detailed description
To evaluate the sources of variance in utilization of neuraxial anesthesia the investigators will use multilevel multivariable modeling strategies. This will allow identification of sources of variation (hospital, vs physician, vs patient characteristics), as well as identification of independent predictors of neuraxial use at each of these three levels. The investigators will also evaluate the independent association of hospital level variation in neuraxial use on our outcomes of interest using multilevel multivariable regression.
Interventions
PROCEDURENeuraxial anesthesia
PROCEDUREGeneral anesthesia
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
66 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Had hip fracture surgery * Admitted to hospital on a non-elective basis
Exclusion criteria
* Do not hold a valid provincial health insurance account
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of Participants With All-Cause Mortality at 30-days | Day of surgery to day of death, or up to 30 days, whichever comes first |
Secondary
| Measure | Time frame |
|---|---|
| Healthcare Costs From the Perspective of the Universal Healthcare System, Using Standardized Methods (Health System Performance Research Network 2013) | Day of surgery to day of death, or 30 days after surgery, whichever comes first |
Other
| Measure | Time frame |
|---|---|
| Hospital Length of Stay | Day of surgery to day of discharge, or up to 365 days, whichever comes first |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Neuraxial Anesthesia Participants in this group will be those who had a spinal or epidural anesthetic without concurrent general anesthesia
Neuraxial anesthesia | 57,080 |
| General Anesthesia Participants in this group will be those who had general anesthesia, including those who had a general plus a concurrent spinal or epidural anesthetic.
General anesthesia | 50,237 |
| Total | 107,317 |
Baseline characteristics
| Characteristic | Neuraxial Anesthesia | General Anesthesia | Total |
|---|---|---|---|
| Age, Continuous | 83 years STANDARD_DEVIATION 7 | 82 years STANDARD_DEVIATION 8 | 83 years STANDARD_DEVIATION 8 |
| Neighbourhood income quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile |
| Sex: Female, Male Female | 41954 Participants | 36874 Participants | 78828 Participants |
| Sex: Female, Male Male | 15126 Participants | 13363 Participants | 28489 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 9,122 / 57,080 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Number of Participants With All-Cause Mortality at 30-days
Time frame: Day of surgery to day of death, or up to 30 days, whichever comes first
Population: Data were not collected from the participants in the General Anesthesia Arm/Group. Only neuraxial group data available for all cause 30-day mortality. The aim was to measure the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival and length of stay and costs.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Neuraxial Anesthesia | Number of Participants With All-Cause Mortality at 30-days | 9122 Participants |
Secondary
Healthcare Costs From the Perspective of the Universal Healthcare System, Using Standardized Methods (Health System Performance Research Network 2013)
Time frame: Day of surgery to day of death, or 30 days after surgery, whichever comes first
Population: Data were not collected from the participants in the General Anesthesia Arm/Group. Only neuraxial group data available for healthcare costs. The aim was to measure the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival and length of stay and costs.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Neuraxial Anesthesia | Healthcare Costs From the Perspective of the Universal Healthcare System, Using Standardized Methods (Health System Performance Research Network 2013) | 22138 Canadian Dollars |
Other Pre-specified
Hospital Length of Stay
Time frame: Day of surgery to day of discharge, or up to 365 days, whichever comes first
Population: Data were not collected from the participants in the General Anesthesia Arm/Group. Only neuraxial group data available for hospital length of stay The aim was to measure the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival and length of stay and costs.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Neuraxial Anesthesia | Hospital Length of Stay | 9 Days |