Hip fracture surgery delays putting vulnerable seniors at risk, expert warns

HN Summary

• Delays beyond 48 hours for hip fracture surgery in older adults significantly increase the risk of death, complications and longer hospital stays. 

• New Canadian Institute for Health Information data show many Canadian hospitals are missing the recommended surgical window, with some major centres reporting rates below 60 per cent. 

• Experts are calling for policy changes, including prioritizing emergency surgeries, flexible staffing models and faster patient stabilization to improve outcomes for seniors. 

A sudden fall and a broken hip. For a frail elderly person, a life-changing medical emergency begins with a broken hip.

Almost everyone who breaks a hip needs surgery to repair the fracture. When an older person falls and breaks their hip, research has found that the timing of when the surgery occurs is one of the most critical factors in the patient’s survival and recovery.

When the waits are longer than two days, or 48 hours, the risks to the patient skyrocket and the consequences are potentially severe. Clinical research shows that delaying hip fracture surgery is associated with higher likelihood of mortality and prolonged expensive hospitalizations. 

Other clinical research has also shown that patients who don’t receive their surgery within 48-hours are more likely to experience postoperative complications from their surgery, including postoperative pneumonia, deep vein thrombosis or muscle atrophy that delays recovery.

So, you’d think with such clear evidence we’d be improving care with rapid response for hip fractures in older adults, right?  You’d be wrong.

Recent statistics made publicly available by the Canadian Institute for Health Information (CIHI) regarding hip fracture repair should give everyone pause. 

The trend is going in the wrong direction in British Columbia. In 2020, 78 per cent of B.C. hip fracture patients received their surgery within the crucial 48-hour period. Most recent data show that the standard was only met for 71 per cent of patients.

Data from B.C.’s biggest hospitals are even more concerning. 

For the fiscal year ended in March 2025, Vancouver’s Providence Health Care met the 48-hour standard only 59 per cent of the time. The rate at Fraser Health’s Royal Columbian Hospital was a dismal 51 per cent. 

If you think this is only a B.C. problem, you’d also be wrong. The Queen Elizabeth II Health Sciences Centre in Nova Scotia reported 65 per cent and the Kingston Health Sciences Centre reported only 58 per cent received their surgery in the crucial 48-hour period.

We can do better. The good news is that we know this dangerous delay is avoidable because some hospitals are succeeding.

Overwhelmed emergency departments cannot be used as an excuse. Some big-city hospitals have figured out how to care for urgent cases. Toronto’s Sinai Health System exceeded 90 per cent and Calgary’s Foothills Medical Centre reported 86 per cent.

Many smaller hospitals are also consistently meeting the 48-hour window. B.C.’s Vernon Jubilee Hospital reported 87 per cent of hip fracture repairs received surgery within the 48-hour standard and Brockville, Ontario’s General Hospital reported 89 per cent.

There are over 23,000 hip fractures occurring across Canada annually. This means that thousands of seniors are enduring agonizing waits in hospital emergency departments, and dangerous delays in their surgeries.

Provincial Ministries of Health must take action to protect our seniors from avoidable suffering. To expedite access to operating rooms for emergency surgery and achieve better health outcomes, four policies are necessary:

First, prioritize stabilizing the patient for surgery. Work-flow redesign is needed to reduce the time stabilizing medically complex patients for surgery by expediting involvement of specialists and imaging. 

Second, prioritize emergency over elective surgery. Hospital policies must empower local decision-makers to cancel elective surgeries to free up operating room space for emergency hip fracture repairs. Anesthesiology should not be managing hip fracture patients’ pain four or more days post-fracture.

Thirdly, fund flexible staffing models in hospitals. These emergent injuries require staffing models that allow for overtime rates or the hiring of travel nurses to keep operating rooms running for emergency surgery. The patients’ families will think the money is well-spent.

Finally, ensure on-call activity is doing its part. Orthopaedic surgery and anesthesia groups hold contracts to provide emergency on-call services in hospitals. Hospitals must ensure these specialists and specialized operating room nurses are available to operate within the 48-hour window, including evenings and holidays.

The clinical evidence regarding rapid intervention is unambiguous and service levels must be met.

Every hour a senior waits for hip fracture repair beyond the 48-hour mark is an hour spent in pain and imperils their recovery. We must do better. 

It is past time to treat broken hips with the urgency they demand and ensure our vulnerable residents get the timely surgery they deserve.

By Jason M. Sutherland

Jason M. Sutherland is the UBC Professor of Health Services and Policy and Director of the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia.

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