Authors: (including presenting author): :
Lin ZH(1), Chow MW(1), Liyeung LL(1), Liu WH(1), Ling KK(1)(2), Mak CK(1), Tang N(1), Wong MY(1)(2), Law SW(1)(2), Yung SH(1)(2)
Affiliation: :
(1)Orthopaedics & Traumatology, Prince of Wales Hospital, (2)Orthopaedics & Traumatology, The Chinese University of Hong Kong
Keyword 1: :
Hip Fracture
Keyword 2: :
Waiting Time
Keyword 3: :
Decision Making
Keyword 4: :
Retrospective Cohort Study
Introduction: :
Timely surgery for geriatric hip fracture is a key quality target under the Hospital Authority’s 48-hour benchmark. Beyond system and clinical factors, patient/family decision-making time is an under-measured source of delay. Our preliminary retrospective analysis at PWH suggests that delayed consent independently prolongs time from emergency/ward admission to operation start, even after adjusting for ASA, and risks breaching the 2-DAY KPI. This protocol formalizes a single-centre retrospective study to quantify decision delay, its determinants, and its impact on surgical timeliness and early outcomes, and to inform a prospective pathway intervention.
Objectives: :
Primary: Association between decision-making delay (hours) and AED/ward admission→operation start (hours).
Secondary: Proportion receiving surgery ≤2-DAY; decomposition of total delay (decision time vs medical optimization vs theatre access); early postoperative complications (e.g., pneumonia, delirium, UTI, SSI), length of stay, and 30-day mortality/readmission (exploratory).
Methodology: :
Retrospective cohort, n = 125, consecutive patients age ≥ 65, Mar 2025–July 2025
Groups: Immediate (n = 66) vs Delayed (n = 59)
Primary outcome: hours from AED to OTS
Welch t / Mann‑Whitney U, ASA‑adjusted linear regression
Patients' inclusion/exclusion criteria
Inclusion: Radiologically confirmed hip fracture, treated with OT or conservative.
Exclusion: Occult fracture with MRI done, pathological or periprosthetic fractures, high-energy polytrauma or multisystem injuries managed on alternative pathways.
Result & Outcome: :
Waiting Time (AED→OTS): Immediate: mean 78.6 h, median 66.5 h; Delayed: mean 123.7 h, median 110.2 h.
Decision‑Making Delay (AED→DDT): Delayed group: mean 34.1 h, median 34.0 h, accounts for a substantial share of total waiting time.
Multivariable Model (ASA‑adjusted): Effect of delayed decision +32.5 h (P = 0.007, 95% CI 9.3–55.8); Effect of ASA: +36.7 h per level (P = 0.002), ASA and decision delay are dominant predictors.
Improve Decision delay could reduce ~1.5 days and more
