Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year

Hommel, Ami; Ulander, Kerstin; Björkelund, Karin Björkman; Norrman, Per Ola; Wingstrand, Hans; Thorngren, Karl–Göran

doi:10.1016/j.injury.2008.01.048

Cited by 139 publications

(128 citation statements)

References 31 publications

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“…Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and physical therapy after surgery decreased the risk. Previous studies showed functional status before fracture [14,42,45,52], male gender [12,15,28,33,36,42,47], older age [10,15,28,36,43,47,50,52,55], and higher ASA scores predicted mortality in older patients [24,26,33,44,49] (Table 3), which is in agreement with our findings. In our study, we did not see a difference in mortality between patients undergoing arthroplasty versus patients undergoing osteosynthesis, which is in agreement with mortality reported by Garcia et al [15] and others [18,33,37].…”

Section: Discussionsupporting

confidence: 93%

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Pereira

Puts

Portela

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Hip fractures in the elderly are common and associated with considerable mortality and disability. Although well known in industrialized countries, the factors associated with mortality after hip fractures are not reported frequently in developing countries and little is known regarding risk factors in Latin America. Questions/PurposeWe investigated the rate of 1-year mortality and prefracture and fracture characteristics associated with mortality after a hip fracture in elderly Brazilian patients in a large metropolitan area. Methods Two hundred forty-six persons 60 years and older admitted to four hospitals in Rio de Janeiro were included after experiencing fractures and were followed for 1 year. Data were collected on sociodemographic, health, and functional status; type of surgery; length of stay; and complications after surgery. Cox regression analyses were conducted to investigate factors associated with 1-year mortality after hip fracture. Results Of the 246 patients, 86 died (35%). Of those 86, 22 died in the hospital (25.6%) and 64 (74.4%) died after discharge. Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and the use of physical therapy after surgery decreased the risk. Conclusions Our mortality rate was higher than those reported from industrialized countries. The use of antibiotics and physical therapy are potentially modifiable factors to improve patients' survival after fracture in Brazil. Level of Evidence Level II, prognostic study. See the Guidelines for Authors for a complete description of the levels of evidence.

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Section: Discussionsupporting

confidence: 93%

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Pereira

Puts

Portela

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…They had no waiting time for rehabilitation at all. In contrast, Hommel et al did not find any significant differences between patients with different kinds of operation types [15].…”

Section: Discussionmentioning

confidence: 83%

“…A recent review by Leigheb et al showed similar reductions in the hospital length of stay in eight out of 12 studies [6]. Three studies reported a longer hospital stay [14][15][16] and one did not find any difference after implementing a clinical pathway [17].…”

Section: Discussionmentioning

confidence: 99%

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Burgers

Lieshout

Verhelst

et al. 2013

International Orthopaedics (SICOT)

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Purpose Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery. Methods This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N =212), and the second was from January 7, 2010 to July 7, 2011 (N =314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions. Results In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p <0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p <0.001); for internal fixation there was no significant difference (five versus six days, p =0.557) and after Gamma nailing it decreased from ten to six days (p <0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p =0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p =0.049). Readmissions for the total group were not different (16 % versus 17 %, p =0.720).Conclusions Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.

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“…This routine includes steps such as giving patients with a suspected hip fracture fluids and pain relief in the ambulance and transiting the patient rapidly from the ambulance to the orthopaedic ward directly after radiography. Fast-track care for hip fracture patients can minimise complications, increase priorities and decrease length of stay (LOS) (Hommel et al, 2008;Larsson and Holgers, 2011;Leigheb et al, 2013). Surgery within 24 hours following fracture reduces hospital stay and may also reduce complications and mortality (Al-Ani et al, 2008;Simunovic et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

Gesar

Hommel

Hedin

et al. 2017

International Journal of Orthopaedic and Trauma Nursing

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Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year

Cited by 139 publications

References 31 publications

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

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