Time from injury to hip-fracture surgery in low-income and middle-income regions: a secondary analysis of data from the International Orthopaedic Multicentre Study in Fracture Care (INORMUS).

Armstrong, E; Rogers, K; Li, CS; Jagnoor, J; Moroz, P; Oguzie, GC; Hailu, S; Miclau, T; de la Huerta, F; Martinez-Ruiz, JDJ; Bidolegui, F; Zhou, J; Ma, X; Wu, B; Sancheti, P; Quang, LN; Baigi, V; Haddadi, M; Tian, M; Sprague, S; Devereaux, PJ; Bhandari, M; Ivers, R; INORMUS Investigators,

Time from injury to hip-fracture surgery in low-income and middle-income regions: a secondary analysis of data from the International Orthopaedic Multicentre Study in Fracture Care (INORMUS).

Armstrong, E Rogers, K

Li, CS Jagnoor, J Moroz, P Oguzie, GC Hailu, S Miclau, T de la Huerta, F Martinez-Ruiz, JDJ Bidolegui, F Zhou, J Ma, X Wu, B Sancheti, P Quang, LN Baigi, V Haddadi, M Tian, M Sprague, S Devereaux, PJ Bhandari, M Ivers, R INORMUS Investigators,

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Lancet Healthy Longev, 2024, 5, (8), pp. e552-e562
Issue Date:: 2024-08

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Field	Value	Language
dc.contributor.author	Armstrong, E
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Li, CS
dc.contributor.author	Jagnoor, J
dc.contributor.author	Moroz, P
dc.contributor.author	Oguzie, GC
dc.contributor.author	Hailu, S
dc.contributor.author	Miclau, T
dc.contributor.author	de la Huerta, F
dc.contributor.author	Martinez-Ruiz, JDJ
dc.contributor.author	Bidolegui, F
dc.contributor.author	Zhou, J
dc.contributor.author	Ma, X
dc.contributor.author	Wu, B
dc.contributor.author	Sancheti, P
dc.contributor.author	Quang, LN
dc.contributor.author	Baigi, V
dc.contributor.author	Haddadi, M
dc.contributor.author	Tian, M
dc.contributor.author	Sprague, S
dc.contributor.author	Devereaux, PJ
dc.contributor.author	Bhandari, M
dc.contributor.author	Ivers, R
dc.contributor.author	INORMUS Investigators,
dc.date.accessioned	2024-09-25T06:04:13Z
dc.date.available	2024-03-26
dc.date.available	2024-09-25T06:04:13Z
dc.date.issued	2024-08
dc.identifier.citation	Lancet Healthy Longev, 2024, 5, (8), pp. e552-e562
dc.identifier.issn	2666-7568
dc.identifier.issn	2666-7568
dc.identifier.uri	http://hdl.handle.net/10453/180981
dc.description.abstract	BACKGROUND: Globally, fall-related injuries are a substantial problem, and 80% of fatal falls occur in low-income and middle-income countries. We aimed to measure time from injury to hip-fracture surgery in people aged 50 years or older living in low-income and middle-income regions, as well as to measure the proportion of patients with surgical stabilisation of their hip fracture within 72 h of admission to hospital and to identify risk factors associated with surgical delay. METHODS: For this secondary analysis, we analysed data collected from Africa, Latin America, China, India, and Asia (excluding China and India) for the International Orthopaedic Multicentre Study in Fracture Care (INORMUS) between March 29, 2014, and June 15, 2022. Patients from INORMUS were included in this analysis if they were aged 50 years or older and had an isolated, primary hip fracture sustained from a ground-level fall. Staff at participating hospitals identified patients with musculoskeletal injury and referred them for assessment of eligibility. We report time from injury to surgery as three distinct time periods: time from injury to hospital admission, time from admission to surgery, and a total time from injury to surgery. Date and time of injury were self-reported by patients at the time of study recruitment. If time to hospital admission after injury exceeded 24 h, patients reported the primary reason for delayed admission. Reasons for surgery, no surgery, and surgical delay were reported by the treating team. For patients undergoing surgery, multivariable regression analyses were used to identify risk factors for surgical delay. FINDINGS: 4486 adults aged 50 years or older with an isolated, primary hip fracture were enrolled in INORMUS from 55 hospitals in 24 countries. Countries were grouped into five regions: Africa (418 [9·3%] of 4486), Latin America (558 [12·4%]), China (1680 [37·4%]), India (1059 [23·6%]) and Asia (excluding China and India; 771 [17·2%]). Of 4486 patients, 3805 (84·8%) received surgery. The rate of surgery was similar in all regions except in Africa, where only 193 (46·3%) of 418 patients had surgery. Overall, 2791 (62·2%) of 4486 patients were admitted to hospital within 24 h of injury. However, 1019 (22·7%) of 4486 patients had delayed hospital admission of 72 h or more from injury. The two most common reasons for delayed admission of more than 24 h were transfer from another hospital (522 [36·2%] of 1441) and delayed care-seeking because patients thought the injury would heal on its own (480 [33·3%]). Once admitted to hospital, 1451 (38·1%) of 3805 patients who received surgery did so within 72 h (median 4·0 days [IQR 1·7-6·0]). Regional variation was seen in the proportion of patients receiving surgery within 72 h of hospital admission (92 [17·9%] of 514 in Latin America, 53 [27·5%] of 193 in Africa, 454 [30·9%] of 1471 in China, 318 [44·4%] of 716 in Asia [excluding China and India], and 534 [58·6%] of 911 in India). Of all 3805 patients who received operative treatment, 2353 (61·8%) waited 72 h or more from hospital admission. From time of injury, the proportion of patients who were surgically stabilised within 72 h was 889 (23·4%) of 3805 (50 [9·7%] of 517 in Latin America, 31 [16·1%] of 193 in Africa, 277 [18·8%] of 1471 in China, 189 [26·4%] of 716 in Asia [excluding China and India], and 342 [37·5%] of 911 in India). INTERPRETATION: Access to surgery within 72 h of hospital admission was poor, with factors that affected time to surgery varying by region. Data are necessary to understand existing pathways of hip-fracture care to inform the local development of quality-improvement initiatives. FUNDING: The National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, McMaster Surgical Associates, Hamilton Health Sciences, and the US National Institutes of Health.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Lancet Healthy Longev
dc.relation.isbasedon	10.1016/S2666-7568(24)00062-X
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	4202 Epidemiology
dc.subject.classification	4206 Public health
dc.subject.mesh	Humans
dc.subject.mesh	Hip Fractures
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Accidental Falls
dc.subject.mesh	Time-to-Treatment
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Risk Factors
dc.subject.mesh	China
dc.subject.mesh	Latin America
dc.subject.mesh	Developing Countries
dc.subject.mesh	Asia
dc.subject.mesh	Poverty
dc.subject.mesh	Time Factors
dc.subject.mesh	Africa
dc.subject.mesh	Humans
dc.subject.mesh	Hip Fractures
dc.subject.mesh	Risk Factors
dc.subject.mesh	Accidental Falls
dc.subject.mesh	Time Factors
dc.subject.mesh	Developing Countries
dc.subject.mesh	Poverty
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Middle Aged
dc.subject.mesh	Africa
dc.subject.mesh	Latin America
dc.subject.mesh	Asia
dc.subject.mesh	China
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Time-to-Treatment
dc.title	Time from injury to hip-fracture surgery in low-income and middle-income regions: a secondary analysis of data from the International Orthopaedic Multicentre Study in Fracture Care (INORMUS).
dc.type	Journal Article
utslib.citation.volume	5
utslib.location.activity	England
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Well-being and Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2024-09-25T06:04:11Z
pubs.issue	8
pubs.publication-status	Published
pubs.volume	5
utslib.citation.issue	8

Abstract:

BACKGROUND: Globally, fall-related injuries are a substantial problem, and 80% of fatal falls occur in low-income and middle-income countries. We aimed to measure time from injury to hip-fracture surgery in people aged 50 years or older living in low-income and middle-income regions, as well as to measure the proportion of patients with surgical stabilisation of their hip fracture within 72 h of admission to hospital and to identify risk factors associated with surgical delay. METHODS: For this secondary analysis, we analysed data collected from Africa, Latin America, China, India, and Asia (excluding China and India) for the International Orthopaedic Multicentre Study in Fracture Care (INORMUS) between March 29, 2014, and June 15, 2022. Patients from INORMUS were included in this analysis if they were aged 50 years or older and had an isolated, primary hip fracture sustained from a ground-level fall. Staff at participating hospitals identified patients with musculoskeletal injury and referred them for assessment of eligibility. We report time from injury to surgery as three distinct time periods: time from injury to hospital admission, time from admission to surgery, and a total time from injury to surgery. Date and time of injury were self-reported by patients at the time of study recruitment. If time to hospital admission after injury exceeded 24 h, patients reported the primary reason for delayed admission. Reasons for surgery, no surgery, and surgical delay were reported by the treating team. For patients undergoing surgery, multivariable regression analyses were used to identify risk factors for surgical delay. FINDINGS: 4486 adults aged 50 years or older with an isolated, primary hip fracture were enrolled in INORMUS from 55 hospitals in 24 countries. Countries were grouped into five regions: Africa (418 [9·3%] of 4486), Latin America (558 [12·4%]), China (1680 [37·4%]), India (1059 [23·6%]) and Asia (excluding China and India; 771 [17·2%]). Of 4486 patients, 3805 (84·8%) received surgery. The rate of surgery was similar in all regions except in Africa, where only 193 (46·3%) of 418 patients had surgery. Overall, 2791 (62·2%) of 4486 patients were admitted to hospital within 24 h of injury. However, 1019 (22·7%) of 4486 patients had delayed hospital admission of 72 h or more from injury. The two most common reasons for delayed admission of more than 24 h were transfer from another hospital (522 [36·2%] of 1441) and delayed care-seeking because patients thought the injury would heal on its own (480 [33·3%]). Once admitted to hospital, 1451 (38·1%) of 3805 patients who received surgery did so within 72 h (median 4·0 days [IQR 1·7-6·0]). Regional variation was seen in the proportion of patients receiving surgery within 72 h of hospital admission (92 [17·9%] of 514 in Latin America, 53 [27·5%] of 193 in Africa, 454 [30·9%] of 1471 in China, 318 [44·4%] of 716 in Asia [excluding China and India], and 534 [58·6%] of 911 in India). Of all 3805 patients who received operative treatment, 2353 (61·8%) waited 72 h or more from hospital admission. From time of injury, the proportion of patients who were surgically stabilised within 72 h was 889 (23·4%) of 3805 (50 [9·7%] of 517 in Latin America, 31 [16·1%] of 193 in Africa, 277 [18·8%] of 1471 in China, 189 [26·4%] of 716 in Asia [excluding China and India], and 342 [37·5%] of 911 in India). INTERPRETATION: Access to surgery within 72 h of hospital admission was poor, with factors that affected time to surgery varying by region. Data are necessary to understand existing pathways of hip-fracture care to inform the local development of quality-improvement initiatives. FUNDING: The National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, McMaster Surgical Associates, Hamilton Health Sciences, and the US National Institutes of Health.

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http://hdl.handle.net/10453/180981