Patient preferences for emergency or planned hip fracture surgery: A cross-sectional study

Background: The ideal timing of surgical management for hip fractures remains controversial. Currently, individual surgeon preference and departmental resources guide decision making regarding the use of emergency or planned operating lists for hip fracture surgery. We evaluated patient preference for emergency or planned surgery. Methods: 102 patients awaiting surgery for a hip fracture at a tertiary hospital were surveyed in this cross-sectional study. After being informed of the benefits and risks associated with an emergency or planned operation, the patients were asked to indicate a hypothetical preference for surgical operating time. They were then asked to give an importance value for six factors that may influence decision making including consultant supervision, operative timeliness, surgical cancellation, after hours operation, length of hospital stay and repeated fasting. For each factor, absolute importance was rated from 0 to 10, and factors were independently ranked for relative importance from 1 to 6. An open ended question was used to include any other factors they thought relevant to their hypothetical decision making. Results: Of the 102 patients surveyed, 95 patients (93%) indicated that they preferred planned over emergency surgery. The most important influencing factor was the presence of specialist supervision (mean rating 9.4, mean rank 1.3) followed by avoidance of operative cancellation (mean rating 8.8, mean rank 2.3) and avoidance of after hours operations (mean rating 8.1, mean rank 3.2). A lower importance was attached to operative timeliness and avoiding prolonged fasting, with reduction in length of hospital stay being the least important variable. There was a direct correlation between absolute ratings and relative rankings independently assigned by patients to each factor. Conclusions: Patients with hip fractures prefer planned rather than emergency surgery, the presence of specialist supervision being the most important factor influencing their preference.