Patient preferences for emergency or planned hip fracture surgery: a cross-sectional study.

Abhinav Aggarwal,Ian A Harris,Justine M Naylor

doi:10.1186/s13018-016-0454-2

Abhinav Aggarwal, Ian A Harris + Show 1 more

Open Access

https://doi.org/10.1186/s13018-016-0454-2

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Abstract

BackgroundThe ideal timing of surgical management for hip fractures remains controversial. Currently, individual surgeon preference and departmental resources guide decision making regarding the use of emergency or planned operating lists for hip fracture surgery. We evaluated patient preference for emergency or planned surgery.Methods102 patients awaiting surgery for a hip fracture at a tertiary hospital were surveyed in this cross-sectional study. After being informed of the benefits and risks associated with an emergency or planned operation, the patients were asked to indicate a hypothetical preference for surgical operating time. They were then asked to give an importance value for six factors that may influence decision making including consultant supervision, operative timeliness, surgical cancellation, after hours operation, length of hospital stay and repeated fasting. For each factor, absolute importance was rated from 0 to 10, and factors were independently ranked for relative importance from 1 to 6. An open ended question was used to include any other factors they thought relevant to their hypothetical decision making.ResultsOf the 102 patients surveyed, 95 patients (93 %) indicated that they preferred planned over emergency surgery. The most important influencing factor was the presence of specialist supervision (mean rating 9.4, mean rank 1.3) followed by avoidance of operative cancellation (mean rating 8.8, mean rank 2.3) and avoidance of after hours operations (mean rating 8.1, mean rank 3.2). A lower importance was attached to operative timeliness and avoiding prolonged fasting, with reduction in length of hospital stay being the least important variable. There was a direct correlation between absolute ratings and relative rankings independently assigned by patients to each factor.ConclusionsPatients with hip fractures prefer planned rather than emergency surgery, the presence of specialist supervision being the most important factor influencing their preference.

Highlights

IntroductionIndividual surgeon preference and departmental resources guide decision making regarding the use of emergency or planned operating lists for hip fracture surgery
The ideal timing of surgical management for hip fractures remains controversial
Emergency surgery is being defined as an operation conducted at the first available opportunity following placement on a shared hospital emergency theatre list that is dictated by clinical urgency and

Summary

Introduction

Individual surgeon preference and departmental resources guide decision making regarding the use of emergency or planned operating lists for hip fracture surgery. Orthopaedic trauma surgery is going through a period of transition whereby trauma cases are being treated as planned events rather than emergencies [1]. In this instance, emergency surgery is being defined as an operation conducted at the first available opportunity following placement on a shared hospital emergency theatre list that is dictated by clinical urgency and Currently, individual surgeon preference and departmental resources guide decision making regarding the use of emergency or planned operating lists for hip fracture surgery. Emergency operations outside of working hours are less likely to be supervised by consultants [14, 15]

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