Journal article
Drivers of Delayed Time to Surgery for Hip Fracture Patients: A Multi-Center Qualitative Study
Journal of the American Academy of Orthopaedic Surgeons, Vol.34(2), pp.e299-e313
01/15/2026
DOI: 10.5435/JAAOS-D-25-00076
PMID: 40758987
Abstract
Delays in time to surgery (TTS) for patients with a hip fracture negatively affect patient outcomes, including mortality. Surgery within 24 to 48 hours of admission for a hip fracture markedly reduces these risks; however, attempts at improving TTS after hip fracture have had mixed results. Drivers of delays in TTS across different settings in the United States are not well described. Therefore, the aim of this study was to identify drivers of delays in TTS for patients with a hip fracture from different settings to inform where patient- and context-specific improvements in TTS may be implemented.
Semistructured interviews were completed using the Consolidated Framework for Implementation Research and Theoretical Domains Framework. Interviews were completed with stakeholders involved in hip fracture care between June 2023 and October 2023. Transcripts were analyzed iteratively through a combined inductive and deductive approach. The data were analyzed to synthesize overarching themes related to drivers of delays of TTS.
A total of 25 stakeholders, 24 orthopaedic surgeons, and 1 nurse practitioner, from 22 different hospital systems across the United States participated in semistructured interviews. Eight themes of drivers of delayed TTS emerged: (1) patient health; (2) structural drivers of health; (3) care coordination; (4) prioritization; (5) improvement climate; (6) availability; (7) incentive structure; and (8) empowerment.
Eight major themes related to drivers in TTS for patients with a hip fracture were identified across hospital systems. These findings inform the process of identifying site-specific drivers of delayed TTS at individual health systems and implementing targeted improvement programs for TTS for patients with a hip fracture.
Details
- Title: Subtitle
- Drivers of Delayed Time to Surgery for Hip Fracture Patients: A Multi-Center Qualitative Study
- Creators
- Emily A Schultz - Stanford UniversityJessica M WelchWilliam CrossKalpit ShahP Kaveh MansuripurMichael KainPamela HolteByung J LeeMatthew BurnKimberly HallMichael WilleyMichael McKeeEric PangMalcolm DeBaunNathan DouglassKenneth EgolDavid LavertyAnna N MillerKyle JerayMara SchenkerLisa K CannadaGiselle HernandezSamir MehtaRosanna WustrackAllison MitchellSaam MorshedMichael GardnerArden MorrisLaurence BakerLauren M ShapiroAlex Sox-HarrisRobin N Kamal
- Resource Type
- Journal article
- Publication Details
- Journal of the American Academy of Orthopaedic Surgeons, Vol.34(2), pp.e299-e313
- DOI
- 10.5435/JAAOS-D-25-00076
- PMID
- 40758987
- NLM abbreviation
- J Am Acad Orthop Surg
- ISSN
- 1067-151X
- eISSN
- 1940-5480
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 08/04/2025
- Date published
- 01/15/2026
- Academic Unit
- Orthopedics and Rehabilitation; Injury Prevention Research Center
- Record Identifier
- 9984944724302771
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