What are the costs of queuing for hip fracture surgery in Canada?

This paper investigates the effect of wait time for hip fracture surgery in Canada on post-surgery length of stay in hospital and inpatient mortality. After controlling for observed and unobserved patient and hospital characteristics, pre-surgery delay has little effect on either of the two outcome variables. Patients from higher income postal-codes experience only slightly shorter delays, and income has no substantial effect on post-surgery outcomes. For hip fracture patients surgery delay may lead to greater pre-surgery inpatient costs and more patient discomfort, but we find no evidence of a detrimental impact on post-surgery outcomes.

[1]  J. Kalbfleisch,et al.  The Statistical Analysis of Failure Time Data , 1980 .

[2]  H. Bingham,et al.  Textbook of Surgery , 1993 .

[3]  J. Heckman,et al.  A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data , 1984 .

[4]  N. Kiefer Economic Duration Data and Hazard Functions , 1988 .

[5]  A. Epstein,et al.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. , 1989, JAMA.

[6]  R. Checketts,et al.  The timing of surgery for intertrochanteric femoral fractures. , 1988, Injury.

[7]  A. Grant,et al.  Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. , 1987, British journal of anaesthesia.

[8]  T. Dolk Operation in hip fracture patients--analysis of the time factor. , 1990, Injury.

[9]  B. Kohler,et al.  The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer , 1993 .

[10]  D. Webster,et al.  The Injury Fact Book , 1984 .

[11]  M. Carrier,et al.  Outcome of rationing access to open-heart surgery: effect of the wait for elective surgery on patient outcome. , 1993, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[12]  H G Welch,et al.  British Columbia sends patients to Seattle for coronary artery surgery. Bypassing the queue in Canada. , 1991, JAMA.

[13]  M. Ta,et al.  Discrete factor approximation for use in simultaneous equation models with both continuous and discrete endogenous variables. , 1992 .

[14]  E P Steinberg,et al.  Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome. , 1991, JAMA.

[15]  G. Volpin,et al.  Results of early and delayed surgical fixation of hip fractures in the elderly: a comparative retrospective study. , 1993, Bulletin (Hospital for Joint Diseases (New York, N.Y.)).

[16]  J. Newhouse,et al.  Hospital spending in the United States and Canada: a comparison. , 1988, Health affairs.

[17]  W. J. Conover,et al.  Practical Nonparametric Statistics , 1972 .

[18]  S. Globerman A policy analysis of hospital waiting lists. , 1991, Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management].

[19]  J. Kenzora Hip fracture mortality. , 1984 .

[20]  C. Bombardier,et al.  Waiting times for knee-replacement surgery in the United States and Ontario. , 1994, The New England journal of medicine.

[21]  C D Naylor,et al.  Waiting for coronary revascularization in Toronto: 2 years' experience with a regional referral office. , 1993, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[22]  C. Bredahl,et al.  Mortality after hip fracture: results of operation within 12 h of admission. , 1992, Injury.

[23]  D A Redelmeier,et al.  Hospital expenditures in the United States and Canada. , 1993, The New England journal of medicine.

[24]  A M Epstein,et al.  The association of payer with utilization of cardiac procedures in Massachusetts. , 1990, JAMA.