Hip Fracture Surgery Within 48 Hours
Higher proportions are desirable.
Unit of Analysis: Episode of care
An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:
- An acute care hospitalization or a same-day surgery visit occurs less than 7 hours after discharge from the previous acute care hospitalization or same-day surgery visit, regardless of whether the transfer is coded;
- An acute care hospitalization or same-day surgery visit occurs between 7 and 12 hours after discharge from the previous acute care hospitalization or same-day surgery visit, and at least one of the hospitalizations or visits has coded the transfer.
Wait time is calculated from the episode start date/time (admission date/time of first acute hospitalization of the episode of care) to the procedure date/time of the hip fracture surgery.
Risk-adjusted rates are reported in Your Health System: In Depth.
Risk-adjusted rate = Observed number of procedures performed within 48 hours ÷ Expected number of procedures performed within 48 hours × Canadian proportion of surgeries performed within 48 hours.
Crude rates based on open-year data from April to September are included in Shared Health Priorities reporting.
Crude rate = Number of cases who received surgery within 48 hours ÷ Number of cases who received surgery, multiplied by 100.
Notes
- For public reporting: Regional and provincial/territorial results are calculated by place of residence; facility results are calculated by place of service.
- For facility-level reporting: For episodes of care that involved transfers, the total wait time is attributed to the hospital where the surgery was performed.
The number of hip fracture episodes among patients age 18 and older that were surgically treated in an acute care hospital
A subset of the denominator and represents the number of hip fracture episodes that were surgically treated within 48 hours of initial admission to an acute care hospital
Methodology
Name
Hip Fracture Surgery Within 48 Hours
Short/Other Names
Wait Times for Hip Fracture Repair: From Inpatient Admission (Percentage Meeting Benchmark) | Adult Patients Who Received Hip Fracture Surgery Within Clinically Acceptable Wait Times
Description
Proportion having surgery within 48 hours:
The proportion of hip fractures that were surgically treated within 48 hours of a patient's initial admission to an acute care hospital, among patients age 18 and older.
For further details, please see the General Methodology Notes (PDF).
Rationale
Wait times for surgery are an important measure of access to care. In 2005, the federal, provincial and territorial governments established the benchmark for hip fracture surgery (within 48 hours) based on research and clinical evidence.
Receiving hip fracture surgery within the clinically acceptable wait time improves outcomes of care, and reduces the risk of prolonged pain, post-surgery complications and even death. Despite the urgent needs of hip fracture patients, their surgery may be delayed for several reasons, including insufficient staffing, unavailability of facility resources and the need to manage other potential illnesses compromising the patient.
Interpretation
Higher proportions are desirable.
HSP Framework Dimension
Health system outputs: Access to comprehensive, high-quality health services
Areas of Need
Getting Better
Targets/Benchmarks
A benchmark of hip fracture fixation within 48 hours was set by federal, provincial and territorial governments in December 2005.
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories except Quebec
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Facility
- Neighbourhood Income Quintile
- Age group
- Recorded sex or gender
- Urban versus rural/remote
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
Description
Unit of Analysis: Episode of care
An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:
- An acute care hospitalization or a same-day surgery visit occurs less than 7 hours after discharge from the previous acute care hospitalization or same-day surgery visit, regardless of whether the transfer is coded;
- An acute care hospitalization or same-day surgery visit occurs between 7 and 12 hours after discharge from the previous acute care hospitalization or same-day surgery visit, and at least one of the hospitalizations or visits has coded the transfer.
Wait time is calculated from the episode start date/time (admission date/time of first acute hospitalization of the episode of care) to the procedure date/time of the hip fracture surgery.
Risk-adjusted rates are reported in Your Health System: In Depth.
Risk-adjusted rate = Observed number of procedures performed within 48 hours ÷ Expected number of procedures performed within 48 hours × Canadian proportion of surgeries performed within 48 hours.
Crude rates based on open-year data from April to September are included in Shared Health Priorities reporting.
Crude rate = Number of cases who received surgery within 48 hours ÷ Number of cases who received surgery, multiplied by 100.
Notes
- For public reporting: Regional and provincial/territorial results are calculated by place of residence; facility results are calculated by place of service.
- For facility-level reporting: For episodes of care that involved transfers, the total wait time is attributed to the hospital where the surgery was performed.
Type of Measurement
Percentage or proportion
Denominator
Description:
The number of hip fracture episodes among patients age 18 and older that were surgically treated in an acute care hospital
Inclusions:
-
- Hip fracture ICD-10-CA codes S72.0, S72.1 or S72.2 as most responsible diagnosis (MRDx), but not also as a diagnosis type (2); or
- Where another diagnosis is coded as MRDx and also a type (2), and a diagnosis of hip fracture is coded as a diagnosis type (1) or (W), (X), (Y) but not also as a diagnosis type (2); or
- Where convalescence or rehabilitation ICD-10-CA codes Z50.1, Z50.8, Z50.9, Z54.0, Z54.4, Z54.7, Z54.8 or Z54.9 are coded as MRDx and hip fracture is coded as diagnosis type (1) or (W), (X), (Y) but not also as a diagnosis type (2).
Note: If hip fracture surgery is not performed during the first (initial) hospitalization of the episode of care, criterion 1 (a, b or c above) must be met on both the initial and surgical record if transfer occurred.
- Criterion 1 (a, b, c) along with a relevant CCI procedure code*:
- 1.VA.74.^^–Fixation, hip joint
- 1.VA 53.^^–Implantation of internal device, hip joint
- 1.VC.74.^^–Fixation, femur
- 1.SQ.53.^^–Implantation of internal device, pelvis
- Age at admission: 18 years and older
- Sex recorded as male or female
- Admission to an acute care institution (Facility Type Code = 1)
- Admission category recorded as emergent/urgent (Admission Category Code = U)
Notes
*Code may be recorded in any position.
Procedures coded as out of hospital and abandoned after onset (status attribute = A or OOH indicator flag = Y) are excluded.
Exclusions:
- Records with an invalid health card number
- Records with an invalid code for province issuing health card number
- Cadaveric donor or stillbirth records (Admission Category Code = R or S)
- Records with an invalid admission date or time
- Records with an invalid discharge date or time
- Records with an invalid procedure date or time
- Records with a discharge status of dead on arrival (Discharge Disposition = 11, 71* for NACRS)
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
Note
*2018–2019 data onward.
Numerator
Description:
A subset of the denominator and represents the number of hip fracture episodes that were surgically treated within 48 hours of initial admission to an acute care hospital
Method of Adjustment
Logistic regression
Adjustment Applied
Covariates used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document.
Geographic Assignment
Place of residence or service
Data Sources
- DAD
- NACRS
Caveats and Limitations
A person can have more than one hip fracture and repair in the reference period; therefore, a person can be included in the indicator more than once.
Due to differences in methodology, this indicator may differ from similar indicators developed and reported by jurisdictions.
Rates for Quebec are not available due to differences in data collection.
Trending Issues
Not applicable
References
Bergeron E, Lavoie A, Moore L, et al. Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma Acute Care Surg 2006;60(4):753-757.
Canadian Association of General Surgeons. Accessed June 28, 2024.
Canadian Institute for Health Information. Health Indicators 2007. Ottawa, ON: CIHI; 2007
Canadian Institute for Health Information. Waiting for Heath Care in Canada: What We Know and What We Don't Know. Ottawa, ON: CIHI; 2006.
Health Canada. Final Report of the Federal Advisor on Wait Times. Ottawa, ON: Health Canada; 2006.
Lepercq D, Gauss T, Gaudier A, et al. Association of organizational pathways with the delay of emergency surgery. JAMA Network Open. 2023.
Ministry of Health and Long-Term Care. First Common Benchmarks Will Allow Canadians to Measure Progress in Reducing Wait Times (press release). Toronto, ON: MOHLTC; December 12, 2005. Accessed from http://news.ontario.ca/archive/en/2005/12/12/First-ever-common-benchmarks-will-allow-Canadians-to-measure-progress-in-reducin.html.
Vidal EL, Moreira-Filho DC, Coeli CM, Camargo KR Jr, Fukushima FB, Blais R. Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality? Osteoporos Int 2009;20(5):723-729
Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 2005;87(3):361-366.
How to cite:
Canadian Institute for Health Information. Hip Fracture Surgery Within 48 Hours. Accessed April 24, 2025.
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Comments
This indicator is part of a set of common indicators to measure progress on the priority areas to improve health care announced by federal, provincial and territorial governments in 2023. Additional information is available on the Shared Health Priorities web page.
Indicator results are also available in