P194 Use of a protocolised estimated discharge date following hip fracture surgery improves discharge planning and reduces length of stay

Background There is no specific recommendation regarding the type of anaesthesia in hip fracture surgery. Objectives This study sought to examine the current local anaesthetic practice (general anaesthesia versus regional anaesthesia (RA)) in hip fracture surgery and to analyse their associations with perioperative outcomes. Methodology A retrospective observational study of hip fracture patients from April to December 2017 was undertaken. Patient characteristics and perioperative outcomes were analysed against the types of anaesthesia using multiple logistic regression. Results One hundred and twelve out of 154 patients (72.7%) had a general anaesthesia. Patients from residential care facilities were more likely to receive general anaesthesia (OR = 2.9, 95% CI: 1.1, 7.4; P = 0.03). There was no significant association between type of anaesthesia and specific postoperative outcomes; however, patients with postoperative delirium and hypotension were more likely to have received general anaesthesia [OR = 1.7, 95% CI: 0.68, 4.38; P = 0.25] and [OR = 1.6, 95% CI: 0.67, 4.04; P = 0.27] respectively). Subgroup analysis showed increased length of stay with patients who underwent general anaesthesia (OR = 1.26, 95% CI:1.04, 1.54; P = 0.02). Conclusion Regional anaesthesia may be considered in patients without contraindications in view of increased risk of postoperative delirium and hypotension, and longer length of stay with general anaesthesia. A larger prospective study is needed to confirm these findings.

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Impact of Diabetes Mellitus on Early Postoperative Outcomes After Hip Fracture Surgery in Geriatric Patients: A Retrospective, Propensity Score Matching Study

10.21203/rs.3.rs-141476/v1 ◽

2021 ◽

Author(s):

Ruibo Li ◽

Xingyue Yuan ◽

Yuehong Liu ◽

Shuping Liu ◽

Yu Zhou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hip Fracture ◽

Blood Transfusion ◽

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Hospital Costs ◽

Hip Fracture Surgery ◽

Fracture Surgery ◽

Total Charges

Abstract Background：The impact of diabetes mellitus (DM) on hip fracture (HF) is still controversial. The primary aim of this study was to examine the influence of DM on perioperative transfusion， the secondary aims were to evaluate 1-year mortality, length of stay，and total charges in individuals with hip fracture.Methods: All patients with initial HF aged 60 years or older admitted to our hospital from January 2014 to January 2018 were eligible for this study. After excluding some patients who did not meet the experimental requirements, 326 HF patients aged 60 years and above were admitted to the study institution, and were divided into DM group (n=71) and non-diabetes mellitus (non-DM) group (n=255). Sex, age, American Society of Anesthesiologists (ASA) classification, anesthesia type and surgery type were matched in the two groups (DM group vs. non-DM group) using propensity score matching (PSM) without any statistical differences. Then，perioperative transfusion，length of stay，direct total charges and 1-year mortality in individuals with HF were compared between two groups.Results: Following PSM, 62 patients in the DM group and 62 patients in the non-DM group were included in the study. Twenty-eight patients had received blood transfusion during the perioperative period, the difference in blood transfusion rate between two groups was statistically significant (p=0.032). There were no statistical differences in 1-year mortality, length of stay and direct hospital costs between two groups.Conclusions: This study showed that DM patients with hip fractures have a higher probability of receiving transfusions compared to patients without DM. Higher blood transfusion rates may be associated with lower hemoglobin and hematocrit levels at admission. However, there was no significant increase in 1-year mortality, length of hospital stay, and direct hospital costs after hip fracture surgery due to diabetes.

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Impact of surgical complications on length of stay after hip fracture surgery

Injury ◽

10.1016/j.injury.2006.08.028 ◽

2007 ◽

Vol 38 (7) ◽

pp. 780-784 ◽

Cited By ~ 21

Author(s):

Nicolai B. Foss ◽

Henrik Palm ◽

Michael Krasheninnikoff ◽

Henrik Kehlet ◽

Peter Gebuhr

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Surgical Complications ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Length of stay and contributing factors in elderly patients who have undergone hip fracture surgery in a tertiary hospital in South Africa

International Journal of Orthopaedic and Trauma Nursing ◽

10.1016/j.ijotn.2019.100748 ◽

2020 ◽

Vol 37 ◽

pp. 100748

Author(s):

Margaret Ntuli ◽

Celia J. Filmalter ◽

Zelda White ◽

Tanya Heyns

Keyword(s):

South Africa ◽

Hip Fracture ◽

Length Of Stay ◽

Elderly Patients ◽

Tertiary Hospital ◽

Contributing Factors ◽

Hip Fracture Surgery ◽

Fracture Surgery

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The effect of anesthetic technique on mortality and major morbidity after hip fracture surgery: a retrospective, propensity-score matched-pairs cohort study

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100417 ◽

2019 ◽

Vol 44 (9) ◽

pp. 847-853 ◽

Cited By ~ 2

Author(s):

Laith Malhas ◽

Anahi Perlas ◽

Sarah Tierney ◽

Vincent W S Chan ◽

Scott Beattie

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Length Of Stay ◽

Propensity Score ◽

Blood Loss ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Anesthetic Technique ◽

Hip Fracture Surgery ◽

Fracture Surgery

IntroductionSpinal anesthesia (SA) has physiological benefits over general anesthesia (GA), but there is insufficient evidence regarding a mortality benefit. We performed a retrospective propensity score-matched cohort study to evaluate the impact of anesthetic technique on mortality and major morbidity in patients undergoing hip fracture surgery.Materials and methodsClinical, laboratory and outcome data were extracted from electronic databases for patients who underwent hip fracture surgery over a 13-year period at the University Health Network in Toronto, Ontario, Canada. The anesthetic technique was documented (SA or GA), and the primary outcome was 90-day mortality. Secondary outcomes included mortality at 30 and 60 days, hospital length of stay, pulmonary embolism (PE), major blood loss and major acute cardiac events. A propensity-score matched-pair analysis was performed following a non-parsimonious logistic regression model.ResultsOf the 2591 patients identified, 883 patients in the SA group were matched to patients in the GA group in a 1:1 ratio. There was a weak association between SA and lower 90-day mortality (risk ratio (RR) 0.74, 95% CI 0.52 to 0.96, 99% CI 0.48 to 1.00, p=0.037). SA was also associated with a lower incidence of both PE (1.3% vs 0.5%, p<0.001) and major blood loss (7.7% vs 4.8%, p<0.001) and a shorter hospital length of stay by about 2 days (median 11.9 vs 10 days, p=0.024). There was no difference in major cardiac events or mortality at 30 and 60 days.DiscussionThis propensity-score matched-pairs cohort study suggests that SA is weakly associated with a lower 90-day mortality following hip fracture surgery. SA was also associated with improved morbidity evidenced by a lower rate of PE and major blood loss and a shorter hospital length of stay. Given the retrospective nature of the study, these results are not proof of causality.

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A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

Anesthesiology ◽

10.1097/aln.0000000000002947 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1025-1035 ◽

Cited By ~ 2

Author(s):

Gavin M. Hamilton ◽

Manoj M. Lalu ◽

Reva Ramlogan ◽

Gregory L. Bryson ◽

Faraj W. Abdallah ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Resource Use ◽

Odds Ratio ◽

Instrumental Variable ◽

Adjusted Odds Ratio ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Hip Fracture Surgery ◽

Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). Methods The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. Results The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. Conclusions Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

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