As the population ages, the prevalence of degenerative spinal conditions is estimated to increase. With soaring healthcare costs, we must be vigilant in our accountability for proper resource allocation to ensure universal access. Significant recent increases in lumbar fusion rates have been observed in the US. Less is known regarding the Canadian experience. Our objective was to evaluate recent trends in lumbar fusion and determine how surgeon factors influence reoperation for spinal stenosis (SS) surgery.

Longitudinal follow-up study of lumbar surgical procedures for SS using administrative databases. Data was gathered on patient-hospital encounters from April 1, 1995 to December 31, 2001. We analyzed trends in spinal fusion. Index procedures (decompressions or fusions) and surgeon variables, such as specialty (orthopaedics, neurosurgery) and volume (above or below thirty cases/year), were selected as predictors of patient reoperation for SS. Adjustments were made for age, gender, and comorbidity. Reoperation rates were evaluated at six weeks, one and two years and until maximal follow-up.

6128 patients were identified (4200 decompressions and 1928 fusions). Proportionally more fusions were performed over the study period when compared to decompressions (1:2.6 in 1995 versus 1:1.5 in 2001). Orthopaedic specialty and higher surgical volume were associated with increased proportion of fusions (p< 0.0001). Reoperation rate was higher for decompressions at two years (OR 1.4) but not at long-term follow-up to ten years. Surgeon specialty had no impact on reoperation rates. Lower surgical volume demonstrated a higher reoperation rate after adjusting for specialty (Hazard Ratio 1.28).

Rates of lumbar spinal fusion have been increasing in Ontario, but at a lesser rate compared with the US. There is wide variation in surgical procedures between surgeon specialty and volume. Surgeon specialty had little impact on reoperation rates. Better long-term survival was observed in spinal surgeons with volumes over thirty cases per year after adjusting for surgeon specialty. Due to increasing rates of spinal fusion, the benefit of improved long-term survival in SS surgery with higher volume surgeons requires more detailed analysis before policy recommendations can be made.

The purpose of this study was to evaluate mortality following delay to surgery in hip fractures in the province of Ontario. All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 were identified using administrative databases. For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95%CI), with similar results at three months and one year. A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for hip fractures.

A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for patients with fractured hips.

This finding will have far reaching implications for the allocation of health resources in the future.

All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 in the Province of Ontario were identified using administrative databases and the provincial mortality database. Multivariable logistic regression models were used to adjust for age, gender, medical comorbidity, type of hip fracture, and teaching status of the treating hospital.

For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95% CI). The adjusted odds of in-hospital mortality increased as the delay to surgery lengthened from a factor of 1.2 [95% CI] with a one day delay to a factor of 1.5 [95% CI] for a delay over two days as compared with patients operated within twenty-four hours. Similar relationships were observed at three months and one year. Even when considering only healthy patients, < 70 years old with no comorbid conditions, the relationship between mortality and surgical delay remained significant (p < 0.0001), suggesting that surgical delay was unlikely to be caused by patient factors alone.

We compared the mortality of hip fracture patients treated in teaching versus community hospitals in Ontario. Hip fracture patients ≥ 50 yrs were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database and linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals.

The purpose of this study was to compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario.

Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals.

This finding will have far-reaching implications for health policy in this province. Hip fracture (ICD-9 code 820) patients ≥ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions.

Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and twelve months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively.

The purpose of this study was to evaluate mortality following delay to surgery in hip fractures in the province of Ontario. All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 were identified using administrative databases. For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95%CI), with similar results at three months and one year. A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for hip fractures.

To evaluate mortality following delay to surgery in hip fractures in the province of Ontario.

A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for patients with fractured hips.

This finding will have far reaching implications for the allocation of health resources in the future.

All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 in the Province of Ontario were identified using administrative databases and the provincial mortality database. Multivariable logistic regression models were used to adjust for age, gender, medical comorbidity, type of hip fracture, and teaching status of the treating hospital.

For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95% CI). The adjusted odds of in-hospital mortality increased as the delay to surgery lengthened from a factor of 1.2 [95% CI] with a one day delay to a factor of 1.5 [95% CI] for a delay over two days as compared with patients operated within twenty-four hours. Similar relationships were observed at three months and one year. Even when considering only healthy patients, < seventy years old with no comorbid conditions, the relationship between mortality and surgical delay remained significant (p < 0.0001), suggesting that surgical delay was unlikely to be caused by patient factors alone.

We compared the mortality of hip fracture patients treated in teaching versus community hospitals in Ontario. Hip fracture patients ≥ 50 yrs were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database and linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals.

To compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. This finding will have far-reaching implications for health policy in this province. Hip fracture (ICD-9 code 820) patients ≥ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions.

Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and twelve months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively.

Introduction and Aims: Surgical delays for non-medical reasons in the management of hip fractures may be detrimental to clinical outcomes. Prior literature is inconclusive, often because of insufficient power and failure to adjust for potential confounding factors. Our aim was to evaluate mortality following delay to surgery in hip fractures in the province of Ontario.

Method: All patients undergoing a surgical procedure for a hip fracture between 1993 and 1999 in the Province of Ontario were identified using administrative databases and the provincial mortality database. Multivariable logistic regression models were used to adjust for age, gender, medical comorbidity, type of hip fracture, and teaching status of the treating hospital.

Results: For every day that surgery was delayed, the adjusted odds of in-hospital mortality increased by a factor of 1.12 times (95% CI). The adjusted odds of in-hospital mortality increased as the delay to surgery lengthened from a factor of 1.2 [95% CI] with a one-day delay to a factor of 1.5 [95% CI] for a delay over two days as compared with patients operated within 24 hours. Similar relationships were observed at three months and one year. Even when considering only healthy patients, < 70 years old with no comorbid conditions, the relationship between mortality and surgical delay remained significant (p < 0.0001), suggesting that surgical delay was unlikely to be caused by patient factors alone.

Conclusion: A significant relationship exists between delay to surgery and mortality in elderly hip fracture patients. Every effort should be made to avoid non-medical delays in providing operative treatment for patients with fractured hips. This finding will have far-reaching implications for the allocation of health resources in the future.

Introduction and Aims: There is significant mortality during the first year after hip fracture. US studies indicate that mortality is lower in teaching than non-teaching hospitals for hip fracture patients. Our aim was to compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario.

Method: Hip fracture (ICD-9 code 820) patients ³ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions.

Results: Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and 12 months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively.

Conclusion: Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. These findings have enormous implications for healthcare providers and health policy-makers.

Introduction and Aims: There is very little scientific evidence of which activities to avoid or which are safe following total hip arthroplasty (THA). Our aims were to conduct a survey of Canadian orthopaedic surgeons’ exercise recommendations after THA and to examine the relation between physical activities and hip pain in THA patients.

Method: Patients who had a primary THA five to seven years previously because of osteoarthritis were administered the well-validated Minnesota Leisure-Time Physical Activity Questionnaire, which assesses the frequency, intensity and duration of physical activities. Patients reported on current physical activities and sports and recalled activity two years after their surgery. They also reported whether they had pain in the affected hip during specific activities and if they reduced their activity because of pain. A survey was mailed to 466 Ontario orthopaedic surgeons to determine the types of physical activities recommended to patients following THA.

Results: Results of the surgeon survey indicate that all surgeons allowed walking, stair climbing and swimming. Nearly all did not allow jogging, squash or racquetball. There was considerable disagreement among the surgeons regarding other activities, e.g., downhill skiing and heavy household activities. Seventy-one male (mean age ± SD; 61 ± 8) and 97 female (61 ± 7) THA patients were interviewed. Over 80% of respondents reported bending and lifting activities. About half the respondents reported non-weightbearing activities such as swimming. A higher proportion of men than women reported golf, racquet sports and shovelling snow, whereas a higher proportion of women than men reported doing housework. Hip pain was most frequently reported during lifting and bending activities. Patients were least likely to report pain during non-weightbearing activities. Nearly all patients who reported pain, reduced their activity level. Thus our preliminary data suggest that bending and lifting impact activities appear to cause the most pain and result in reduced activity levels. Our results also show that some patients participate and experience pain in non-recommended activities. Some allowed activities, such as stair climbing, cause pain.

Conclusion: Bending and lifting activities cause the most pain and result in reduced activity. Patients participate and experience pain in activities that surgeons do not recommend. Some recommended activities cause pain. This is one of the first studies to quantify activity and show a relation between activities and pain in THA patients.

Death during the first year after hip fracture may be influenced by the type of hospital in which patients are treated as well as the time spent awaiting surgery. We studied 57 315 hip fracture patients who were admitted to hospital in Ontario, Canada. Patients treated in teaching hospitals had a decreased risk of in-hospital mortality (odds ratio (OR) 0.89; 95% confidence interval (CI) 0.83 to 0.97) compared with those treated in urban community institutions. There was a trend toward increased mortality in rural rather than urban community hospitals. In-hospital mortality increased as the surgical delay increased (OR 1.13; 95% CI 1.10 to 1.16) for a one-day delay and higher (OR 1.60; 95% CI 1.42 to 1.80) for delays of more than two days. This relationship was strongest for patients younger than 70 years of age and with no comorbidities but was independent of hospital status. Similar relationships were seen at three months and one year after surgery. This suggests that any delay to surgery for non-medical reasons is detrimental to a patient’s outcome.