The association of female sex with application of evidence-based practice recommendations for perioperative care in hip fracture surgery

Background — Sex and gender inequality is prevalent in healthcare, and affects receipt of healthcare services and outcomes. Our objective was to measure the association between sex and receipt of evidence-based perioperative care for hip fracture in Ontario.

Methods — This was a population-based retrospective cross-sectional analysis. We identified all Ontario residents aged 66 years and older who had hip fracture surgery between 2014 and 2016. After protocol registration, we measured the adjusted association between female sex and perioperative geriatric care (primary outcome), anesthesia consultations, regional analgesia and neuraxial anesthesia (secondary outcomes) using multilevel multivariable adjusted logistic regression. Pre-specified sensitivity analyses were also performed.

Results — We identified 22 661 patients who had hip fracture surgery; 16 162 (71.3%) were women. Women were less likely to receive perioperative geriatric care (adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.72 to 0.88) and anesthesia consultations (adjusted OR 0.89, 95% CI 0.80 to 0.98); women were more likely to have timely surgery (adjusted OR 1.26, 95% CI 1.17 to 1.36). Receipt of neuraxial anesthesia (adjusted OR 0.98, 95% CI 0.93 to 1.04) and regional analgesia (adjusted OR 1.00, 95% CI 0.94 to 1.07) were not different between sexes.

Interpretation — More than 2 out of 3 patients who had hip fracture surgery were women; however, women were less likely to receive perioperative geriatric care and anesthesia consultations. Given the effectiveness of these interventions for improving outcomes, population-level hip fracture outcomes may be improved by decreasing sex-based disparities in application of evidence-based recommended perioperative care.