{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T20:43:10Z","timestamp":1758055390333,"version":"3.44.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to investigate in patients over 65 with neck of femur (NOF) fractures in Rural Australia, does initial presentation to a peripheral hospital result in a delay to surgery?<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Dubba Base Hospital, Trauma Hospital Rural Australia\u00a0(Modified Monash Model (MMM) 3) and catchment area (MMM 3\u20137), NSW, Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>The study includes 350 patients over 65, presenting with closed, unilateral NOF fractures who underwent operative management at the operating centre, 203 from peripheral hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Primary outcomes include time to surgery and adherence to recommended timeframes for NOF fixation. Secondary outcomes encompass complications, hospital length of stay and a subgroup analysis to identify causes of surgery delay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients transferred from peripheral hospitals experienced a statistically significant delay in time from presentation to surgery compared to those presenting directly to the operating centre (42\u2009h vs. 24\u2009h, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and were more likely to be outside of current guidelines for NOF fixation within 36\u2009h of presentation (OR 5.1, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There were no differences in mortality at 1\u2009year between the two groups (15% vs. 18%, <jats:italic>p<\/jats:italic>\u2009=\u20090.5). On subgroup analysis, distance from the operating centre, time to x\u2010ray and after\u2010hours presentation were associated with increased likelihood of surgery outside of 36\u2009h in the peripheral hospital group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study underscores an inequity in service delivery for rural patients with NOF fractures, particularly those requiring transfer. Pre\u2010arrival delays necessitate targeted interventions to address diagnostic service delays, logistical challenges and transport issues in rural health care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajr.13200","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T02:07:02Z","timestamp":1732586822000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does distance to hospital and interhospital transfer negatively impact time to definitive fixation and outcomes in patients with fractured neck of femur in a rural setting?"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8618-3634","authenticated-orcid":false,"given":"Geoffrey T.","family":"Murphy","sequence":"first","affiliation":[{"name":"Royal Prince Alfred Hospital  Camperdown New South Wales Australia"},{"name":"Dubbo Base Hospital  Dubbo New South Wales 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