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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Male hip fracture surgery patients | 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 |
| |
| Female hip fracture surgery patients | 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 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Male sex | Other | Male sex-as listed in the discharge abstract database |
|
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion criteria
-None
Sex based on that listed in the discharge abstract database (not self-reported)
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Emergency hip fracture surgery patients
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30745399 | Derived | Cho N, Boland L, McIsaac DI. The association of female sex with application of evidence-based practice recommendations for perioperative care in hip fracture surgery. CMAJ. 2019 Feb 11;191(6):E151-E158. doi: 10.1503/cmaj.180564. |
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Privacy policies in our institution preclude data sharing
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| D063507 | Sexism |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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| Female sex | Other | Male sex-as listed in the discharge abstract database |
|
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 |
| D007869 |
| Leg Injuries |
| D011287 | Prejudice |
| D012919 | Social Behavior |
| D001519 | Behavior |
| D063508 | Social Discrimination |