Introducing a 30-day mortality predictive score for post-op neck of femur fractures

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

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Management of Simultaneous Bilateral Neck of Femur Fractures in an Elderly Patient

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458513511626 ◽

2013 ◽

Vol 4 (3) ◽

pp. 71-73 ◽

Cited By ~ 10

Author(s):

Niall P. McGoldrick ◽

Michael K. Dodds ◽

Connor Green ◽

Keith Synnott

Keyword(s):

Elderly Patient ◽

Neck Of Femur ◽

Femur Fractures

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Analysis of total hip arthroplasty for displaced intracapsular neck of femur fractures in a tertiary referral trauma centre

Injury Extra ◽

10.1016/j.injury.2012.07.295 ◽

2012 ◽

Vol 43 (10) ◽

pp. 105

Author(s):

Z. Gamie ◽

J. Neale ◽

D. Shields ◽

J. Claydon ◽

S. Hazarika ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Trauma Centre ◽

Tertiary Referral ◽

Neck Of Femur ◽

Total Hip ◽

Femur Fractures

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Impaired cognitive function and its effect on the management of pain in neck of femur fractures

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.053 ◽

2014 ◽

Vol 12 ◽

pp. S63-S64

Author(s):

Dilan Pathmajothy ◽

James Bowyer ◽

Thomas Knapper ◽

David Clarke

Keyword(s):

Cognitive Function ◽

Neck Of Femur ◽

Impaired Cognitive Function ◽

Femur Fractures

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P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

BJS Open ◽

10.1093/bjsopen/zrab032.015 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

O A Javed ◽

M J Khan ◽

Y Abbas ◽

S Pillai ◽

K Hristova ◽

...

Keyword(s):

Risk Assessment ◽

Elderly Patients ◽

Bone Health ◽

Nutritional Assessment ◽

Femur Fracture ◽

Femoral Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

Health Review

Abstract Introduction Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients. Methods A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review. Results Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%). Discussion Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

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Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

CLINICAL CASES IN MINERAL AND BONE METABOLISM ◽

10.11138/ccmbm/2016.13.1.038 ◽

2016 ◽

Cited By ~ 1

Author(s):

SK Khan

Keyword(s):

Bisphosphonate Treatment ◽

Neck Of Femur ◽

Femur Fractures ◽

Atypical Variant

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Cemented Thompson’s hemiarthroplasty in patients with intracapsular neck of femur fractures: survival analysis of 1,670 procedures

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-014-1521-1 ◽

2014 ◽

Vol 25 (4) ◽

pp. 655-660 ◽

Cited By ~ 7

Author(s):

S. K. Khan ◽

S. S. Jameson ◽

A. Sims ◽

J. A’Court ◽

M. R. Reed ◽

...

Keyword(s):

Survival Analysis ◽

Neck Of Femur ◽

Femur Fractures

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463 THE USE OF FERINJECT TO MANAGE IRON DEFICIENCY ANAEMIA IN PATIENTS WITH NECK OF FEMUR FRACTURES

Age and Ageing ◽

10.1093/ageing/afab116.04 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii8-ii13

Author(s):

O Meakin ◽

S Adejumo

Keyword(s):

Iron Deficiency ◽

Patient Group ◽

Iron Deficiency Anaemia ◽

Eligible Patient ◽

Blood Transfusions ◽

Neck Of Femur ◽

Improvement Project ◽

Deficiency Anaemia ◽

Femur Fractures ◽

Iron Deficient

Abstract Introduction Iron-deficiency anaemia is a condition that is regularly seen in patients admitted with neck of femur fractures (NOFF) and is associated with increased morbidity peri-operatively. Intravenous ferinject is a method of iron replacement that leads to a more rapid increase in haemoglobin than oral replacement, therefore is often more favourable in this patient group, leading to better patient outcomes. Method A quality improvement project was undertaken. An initial audit was conducted to analyse the demographic of patients with NOFF and to assess the current practice of the orthogeriatric team when managing iron deficiency anaemia. This reviewed NOFF patients admitted in July 2017. The indications and benefits of ferinject were distributed to the medical team, encouraging use clinically, and a further audit was performed 2 years later to compare outcomes and practice, reviewing patients with NOFF admitted July–September 2019. Results It was found that 87% of patients with NOFF are iron-deficient on admission, and that introducing the use of ferinject meant that 50% fewer blood transfusions were required. Additionally, it highlighted that those who received ferinject during their admission had a smaller range of discharge haemoglobin levels than those who did not. Finally, it was found that the use of ferinject did not affect the rates of readmission in the assessed patient cohort. Conclusions The introduction of the use of ferinject in NOFF patients with iron-deficiency anaemia leads to a reduction in the requirement of blood transfusions required and to a reduction of the range of discharge haemoglobin levels. Ferinject therefore aids in improved recovery of NOFF patients. It does not, however, appear to have any effect on readmission rates in this patient group. Further education is required amongst the orthogeriatric team about the indications and benefits of ferinject to ensure that all eligible patient receive ferinject, improving their recovery.

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