Poster 1: Joint Replacement and Hip Fracture Readmission Rates: Impact of Discharge Destination

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

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Discharge destination after hip fracture: findings from the Irish hip fracture database

European Geriatric Medicine ◽

10.1007/s41999-021-00556-7 ◽

2021 ◽

Author(s):

H. Ferris ◽

L. Brent ◽

J. Sorensen ◽

E. Ahern ◽

T. Coughlan

Keyword(s):

Hip Fracture ◽

Discharge Destination

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Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

BMC Geriatrics ◽

10.1186/s12877-019-1289-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Carl Neuerburg ◽

Stefan Förch ◽

Johannes Gleich ◽

Wolfgang Böcker ◽

Markus Gosch ◽

...

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Activities Of Daily Living ◽

Trauma Care ◽

Daily Living ◽

Aging Population ◽

Readmission Rates ◽

Term Outcome ◽

Long Term Outcome

Abstract Background Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. Thus, an interdisciplinary orthogeriatric treatment of these patients has recognized a growing acceptance in the last years. As there is still limited data on the impact of this approach, the present study aimed to evaluate the long-term outcome in elderly hip fracture patients, by comparing the treatment of a hospital with integrated orthogeriatric care (OGC) with a conventional trauma care (CTC). Methods We conducted a retrospective, two-center, cohort study. In two maximum care hospitals all patients presenting with a hip fracture at the age of ≥ 70 years were consecutively assigned within a 1 year period and underwent follow-up examination 12 months after surgery. Patients treated in hospital site A were treated with an interdisciplinary orthogeriatric approach (co-managed care), patients treated in hospital B underwent conventional trauma care. Main outcome parameters were 1 year mortality, readmission rate, requirement of care (RC) and personal activities of daily living (ADL). Results A total of 436 patients were included (219 with OGC / 217 with CTC). The mean age was 83.55 (66–99) years for OGC and 83.50 (70–103) years for CTC (76.7 and 75.6% of the patients respectively were female). One year mortality rates were 22.8% (OGC) and 28.1% (CTC; p = 0.029), readmission rates were 25.7% for OGC compared to 39.7% for CTC (p = 0.014). Inconsistent data were found for activities of daily living. After 1 year, 7.8% (OGC) and 13.8% (CTC) of the patients were lost to follow-up. Conclusions Interdisciplinary orthogeriatric management revealed encouraging impact on the long-term outcome of hip fracture patients in the aging population. The observed reduction of mortality, requirements of care and readmission rates to hospital clearly support the health-economic impact of an interdisciplinary orthogeriatric care on specialized wards. Trial registration The study was approved and registered by the bavarian medical council (BLAEK: 7/11192) and the local ethics committee of munich university (Reg. No. 234–16) and was conducted as a two-center, cohort study at a hospital with integrated orthogeriatric care and a hospital with conventional trauma care.

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The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

Calcified Tissue International ◽

10.1007/s00223-020-00722-2 ◽

2020 ◽

Vol 107 (4) ◽

pp. 319-326 ◽

Cited By ~ 3

Author(s):

Radcliffe Lisk ◽

Keefai Yeong ◽

David Fluck ◽

Christopher H. Fry ◽

Thang S. Han

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Adverse Events ◽

Nursing Care ◽

Risk Group ◽

Area Under The Curve ◽

High Risk Group ◽

Discharge Destination ◽

Increased Risk ◽

Surgery Rates

Abstract The Nottingham Hip Fracture Score (NHFS) has been developed for predicting 30-day and 1-year mortality after hip fracture. We hypothesise that NHFS may also predict other adverse events. Data from 666 patients (190 men, 476 women), aged 60.2–103.4 years, admitted with a hip fracture to a single centre from 1/10/2015 and 7/12/2017 were analysed. The ability of NHFS to predict mobility within 1 day after surgery, length of stay (LOS) find mortality, and discharge destination was evaluated by receiver operating characteristic curves and two-graph plots. The area under the curve (95% confidence interval [CI]) for predicting mortality was 67.4% (58.4–76.4%), prolonged LOS was 59.0% (54.0–64.0%), discharge to residential/nursing care was 62.3% (54.0–71.5%), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care was 64.8% (59.0–70.6%). NHFS thresholds at 4 and 7 corresponding to the lower and upper limits of intermediate range where sensitivity and specificity equal 90% were identified for mortality and prolonged LOS, and 4 and 6 for discharge to residential/nursing care, which were used to create three risk categories. Compared with the low risk group (NHFS = 0–4), the high risk group (NHFS = 7–10 or 6–10) had increased risk of in-patient mortality: rates = 2.0% versus 7.1%, OR (95% CI) = 3.8 (1.5–9.9), failure to mobilise within 1 day of surgery: rates = 18.9% versus 28.3%, OR = 1.7 (1.0–2.8), prolonged LOS (> 17 days): rates = 20.3% versus 33.9%, OR = 2.2 (1.3–3.3), discharge to residential/nursing care: rates = 4.5% vs 12.3%, OR = 3.0 (1.4–6.4), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care: rates = 10.5% versus 28.6%, 3.4 (95% CI 1.9–6.0), and stayed 4.1 days (1.5–6.7 days) longer in hospital. High NHFS associates with increased risk of mortality, prolonged LOS and discharge to residential/nursing care, lending further support for its use to identify adverse events.

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The Predictive Value of the Clinical Frailty Scale on Discharge Destination and Complications in Older Hip Fracture Patients

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001518 ◽

2019 ◽

Vol 33 (10) ◽

pp. 497-502 ◽

Cited By ~ 4

Author(s):

Sarah Chan ◽

Eric K. C. Wong ◽

Sarah E. Ward ◽

David Kuan ◽

Camilla L. Wong

Keyword(s):

Hip Fracture ◽

Predictive Value ◽

Discharge Destination ◽

Clinical Frailty Scale

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Comparison of 3 Different Perioperative Care Models for Patients With Hip Fractures Within 1 Health Service

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517692651 ◽

2017 ◽

Vol 8 (2) ◽

pp. 87-93 ◽

Cited By ~ 5

Author(s):

Lillian Sarah Coventry ◽

Austin Nguyen ◽

Amalia Karahalios ◽

Sasha Roshan-Zamir ◽

Phong Tran

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Perioperative Care ◽

Health Care Facilities ◽

Discharge Destination ◽

Medical Problems ◽

Care Facilities ◽

Care Models ◽

To Receive

Introduction: Orthogeriatric care models have been introduced within many health-care facilities to improve outcomes for hip fracture patients. This study aims to evaluate differences in care between 3 models, an orthopedic model, a geriatric model, and a comanaged model. Materials and Methods: A retrospective analysis was conducted for hip fracture patients treated at Western Health between November 2012 and March 2014. All patients aged 65 years or older were included in the analysis. Results: There were 183 patients in the orthopedic model, 137 in the geriatric model, and 126 in the comanaged model. Demographics and clinical characteristics were similar across the 3 models. Length of stay, mortality, and discharge destination were also consistent across the 3 groups. However, groups involving geriatricians were more likely to receive preoperative medical assessments, have greater recognition of postoperative medical problems, and have implementation of long-term osteoporosis management. Conclusion: The involvement of geriatricians in perioperative care models resulted in more comprehensive medical care without impacting length of stay, mortality, or discharge destination.

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