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Mortality Worsening After Delayed Hip Fracture Surgery: Factors And Relationships
The effect of surgical delay in patients with hip fracture is debated. Consequently, surgical services may underutilize expedited surgery when it could save lives. The uncertainty results in part from failure to control factors that produce a statistical association between timing of surgery and death when they are not causally related. We summarize what is known about factors that influence, directly or indirectly, both timing of surgery and occurrence of death. We present a composite description of phenomena involved in worsening mortality after delayed surgery by a dependency graph. This approach identifies chains of dependencies inducing association of timing and death. Accounting for those dependencies informs resource allocation to prevent adverse consequences of delaying hip fracture surgery.
Learning Objectives (Take Home Messages): At the end of this session, participants will be able to:
- Describe the burden of hip fracture.
- Identify factors involved in the putative association between timing of surgery and death.
- List potential confounders which produce variation in both timing and death.
- Describe practice implications from knowledge of potential confounders.