The Association of Sex With Guideline-based Perioperative Care in Hip Fracture Surgery

Study Overview
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Brief Summary
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The investigators will use multilevel multivariable regression analysis to measure the association of sex with provision of guideline-based perioperative care for hip fracture surgery in Ontario.

Detailed Description
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In 2013, the Ontario Ministry of Health and Longterm Care published a 'Quality Based Procedures' guideline for care of hip fracture patients. The adjusted association of sex with receipt of 5 perioperative processes of care that can be accurately measured in health administrative data within this guideline will be investigated.

Official Title
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The Association of Sex With Provision of Guideline-based Perioperative Care for Hip Fracture Surgery Patients: a Population-based Study

Conditions
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Hip Fractures, Gender Bias, Surgery, Anesthesia

Intervention / Treatment
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* Other: Male sex
* Other: Female sex


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Non-elective hospital admission Hip fracture diagnosis Hip fracture surgery Exclusion criteria -None

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Male hip fracture surgery patients<br>Individuals 65 years or older admitted non-electively to hospital with a diagnosis of hip fracture who have surgery for their hip fracture and have male sex listed in their discharge abstract | Other: Male sex<br>* Male sex-as listed in the discharge abstract database<br>|
| Female hip fracture surgery patients<br>Individuals 65 years or older admitted non-electively to hospital with a diagnosis of hip fracture who have surgery for their hip fracture and have female sex listed in their discharge abstract | Other: Female sex<br>* Male sex-as listed in the discharge abstract database<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perioperative geriatric medicine consult | Physician billing code for perioperative, inpatient geriatric medicine consult or comprehensive assessment | Hospital admission to date of discharge from hospital, or 365 days after admission, whichever came first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preoperative anesthesiology consult | Physician billing code for preoperative, inpatient anesthesiology consult | Hospital admission to date of surgery, or 365 days after admission, whichever came first | 
| Wait for surgery greater than 2 days | Hospital admission to surgery wait for greater than 2 days | Hospital admission to date of surgery, or 365 days after admission, whichever came first | 
| Perioperative regional analgesia | Peripheral nerve block or epidural administered in the perioperative period, identified from physician billing data codes | Hospital admission to 3 days after surgery | 
| Neuraxial anesthesia | Spinal or epidural anesthesia, without concurrent general anesthesia, administered for the hip fracture surgery and identified from the discharge abstract database section which describes anesthesia techniques for surgery. | Day of surgery |