Delay to operative treatment of femoral fractures in the province of Quebec - effects on complications and cost of care
Bibliographic record
Abstract
Waiting time to access medical care in Canada is 20% more than the international average. Delayin instituting care in trauma patients has been shown to be associated with higher complicationrates and an increase in mortality. Whenever complications occur during patient care, it usuallyresults in increased cost of care. Femur fractures constitute about 11% of all fractures and areusually treated operatively. Delay in operative treatment is a source of distress to these patientsand a major factor for poor outcome. Knowledge gaps exist for statistics on operative delay tofixation of isolated femur fractures and the influence on complications and cost of treatment.This study describes (1) the burden and effect of delay to operative fixation of fractures of thefemur on the occurrence of complications as well as on the overall cost of care in hospitals withinthe Province of Quebec. Other objectives include: (2) to compare reoperation rates between adultpatients with and without delayed surgeries. (3) To propose a time frame within which femurfractures should be operatively treated in order to minimize the risk of complications and to reducetreatment cost.6,520 adult patients operatively treated for closed femoral fractures between July 1993 andDecember 2002 were recruited into this study. Data was accessed from the Quebec TraumaRegistry, the MED-ECHO and the RAMQ databases of costs for medical treatments. Detailsobtained from the registry included: demographic information of the patients, time of injury andother details of the injury, time of arrival in the emergency room, Injury Severity Score (ISS), typeand location of the femur fracture, and method/type of operative fracture stabilization. Outcomemeasures included length of hospital stay, cost of treatment, re-operations and early post-operativecomplications. Patients with poly-trauma, open fractures, fractures occurring in diseased bone andthose with missed diagnosis for longer than one week were excluded.Data analysis was carried out using the SPSS software version 17.0. Cases were stratified basedon the parts of the femur that are fractured. Cost analysis was carried out using parametrictechniques based on the Student’s t-test and the generalized longitudinal model.Operative delay to fracture stabilization was associated with increased complications, ICU stay,LOS and increased costs of hospitalization as well as out-patient follow-up treatment. There wasa progressive increase in the tendency to these adverse events which was quite significant after thefirst 48 hours of delay. Injury severity scores (ISS) >15 was another factor which predisposed toprolonged ICU stay, LOS and increased cost of treatment. Femur fractures, irrespective of whichpart of the bone was involved, were commoner in over-65 year-olds and women.This study identified the major cost drivers of operative treatment of femur fractures namely,ISS>15, operative delay ≥48 hours, occurrence of complications, and re-operations. Efforts atminimizing operative delay in femur fractures will help not only to mitigate patient suffering, butalso bring about a reduction in the cost of treatment and follow-up
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".