Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur

Background: Hip fractures are common presentations to orthopaedic departments, and their surgical management often results in blood transfusions. Compared with general anaesthesia, regional anaesthesia reduces the need for transfusions and mortality in the wider surgical population. Aims: In hip fracture patients, our primary outcome measure was to examine any relationship between anaesthetic modality and transfusion rates. The secondary outcome measure was to assess the relationship between anaesthetic modality and one-year mortality. Methods: A retrospective cohort study of 280 patients was carried out in 2017 and 2018. Data were collected from patient records, local transfusion laboratory and the national hip fracture database. Results: A total of 59.6% had regional and 40.4% general anaesthesia. Regional anaesthesia patients were younger with fewer comorbidities (p < .05). About 19.8% regional and 34.5% general anaesthesia patients received transfusions (odds ratio (OR) = 0.47, p < .05); 13.6% were taking anticoagulants and were less likely to receive a regional anaesthetic (31.6% versus 64%, OR = 0.26, p < .05). One-year mortality was 27% for regional and 37% for general anaesthetic patients (OR = 0.64, p = .09). Conclusion: Regional anaesthesia halved the risk of blood transfusion. Anticoagulated patients were 74% less likely to receive regional anaesthetics, but had no additional transfusion risk. With optimisation, a larger proportion of patients could have regional anaesthesia.

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Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: one-year follow-up

Aging Clinical and Experimental Research ◽

10.1007/bf03324779 ◽

2008 ◽

Vol 20 (3) ◽

pp. 253-259 ◽

Cited By ~ 39

Author(s):

Andrea Giusti ◽

Antonella Barone ◽

Monica Razzano ◽

Monica Pizzonia ◽

Mauro Oliveri ◽

...

Keyword(s):

Hip Fracture ◽

Hospital Readmission ◽

Surgical Repair ◽

One Year

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Predictors of direct home discharge following fractured neck of femur

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0021 ◽

2017 ◽

Vol 99 (6) ◽

pp. 444-451 ◽

Cited By ~ 3

Author(s):

O Salar ◽

PN Baker ◽

DP Forward ◽

BJ Ollivere ◽

N Weerasuriya ◽

...

Keyword(s):

Hip Fracture ◽

Trauma Centre ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Mental Test Score ◽

Hip Fracture Surgery ◽

Home Discharge ◽

Walking Aids ◽

Major Trauma Centre ◽

Alternative Location

INTRODUCTION Direct home discharge (DHD) following hip fracture surgery represents a challenging proposition. The aim of this study was to identify factors influencing the discharge destination (home vs alternative location) for patients admitted from their own home with a fractured neck of femur. METHODS A retrospective cohort study of prospectively collected major trauma centre data was performed, identifying 10,044 consecutive hip fracture admissions between 2000 and 2012. RESULTS Two-thirds of the patients (n=6,742, 67%) were admitted from their own home. Half of these (n=3,509, 52%) returned directly to their own home while two-fifths (n=2,640, 39%) were discharged to an alternative location; 593 (9%) died. The following were identified as independent variables associated with a higher likelihood of DHD: younger patients, female sex, an abbreviated mental test score of 10, absence of certain co-morbidities, cohabiting, walking independently outdoors, no use of walking aids, no assistance required with basic activities of daily living and intracapsular fracture. CONCLUSIONS Identifying those at risk of being discharged to an alternative location following admission from home on the basis of identified preoperative indices could assist in streamlining the postoperative care phase. Pre-emptive action may help increase the numbers of patients discharged directly home and reduce the number requiring additional rehabilitation prior to discharge home with its associated socioeconomic effect.

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Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study

Advances in Orthopedics ◽

10.1155/2018/4791214 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Thomas S. Moores ◽

Benjamin D. Chatterton ◽

Matthew J. Walker ◽

Phillip J. Roberts

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Length Of Stay ◽

Nearest Neighbour ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

The United Kingdom ◽

Before And After ◽

Warfarin Reversal ◽

Guideline Group

Background. This study aims to evaluate outcomes for warfarinised hip fracture patients and compare them with a matched nonwarfarinised group, before and after the introduction of national hip fracture guidelines in the United Kingdom. Methods. A retrospective cohort study of 1743 hip fracture patients was undertaken. All patients admitted taking warfarin were identified. These patients were then matched to nonwarfarinised patients using nearest neighbour propensity score matching, accounting for age, sex, hip fracture type, and Nottingham Hip Fracture Score. A pre-guideline group (no standardised warfarin reversal regimen) and a post-guideline group (standardised regimen) were identified. Outcomes assessed included time to INR less than 1.7, time to theatre, length of stay, and 30-day and 1-year mortality. Results. Forty-six warfarinised hip fracture patients were admitted in the pre-guideline group (mean age 80.5, F:M 3:1) and 48 in the post-guideline group (mean age 81.2 years, F:M 3:1). Post-guideline patients were reversed to a safe operative INR level within 18 hours of admission, decreasing the time to first dose vitamin K (p<0.001). 70% of warfarinised patients were operated upon within 36 hours, compared to 19.6% with no regimen (p<0.05). After anticoagulation reversal protocol, thirty-day mortality decreased from 15.2% to 8.3% and 1-year mortality from 43.5% to 33% for warfarinised patients, which is comparable to nonwarfarinised matched patients. There was no significant change in the length of stay pre- and post-guideline for both groups of patients. Conclusions. Proactive anticoagulant management and expedient surgery reduces morbidity and mortality when managing this surgically challenging subset of hip fracture patients.

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Does achieving the ‘Best Practice Tariff’ criteria for fractured neck of femur patients improve one year outcomes?

Injury ◽

10.1016/j.injury.2019.06.007 ◽

2019 ◽

Vol 50 (7) ◽

pp. 1358-1363 ◽

Cited By ~ 2

Author(s):

Samuel R. Whitaker ◽

Sohail Nisar ◽

Andrew J. Scally ◽

Graham S. Radcliffe

Keyword(s):

Best Practice ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

One Year

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Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609954815 ◽

2013 ◽

Vol 95 (1) ◽

pp. 26-28 ◽

Cited By ~ 20

Author(s):

WKM Kieffer ◽

CS Rennie ◽

AJ Gandhe

Keyword(s):

Serum Albumin ◽

Statistical Significance ◽

Postoperative Mortality ◽

Decision Making Process ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Operative Planning ◽

Implant Selection ◽

One Year ◽

Preoperative Albumin

A simple measure to determine one-year mortality following hip fractures has its benefits. Where there is controversy over implant selection, such a scoring system can facilitate the decision-making process. We undertook a retrospective analysis of one-year postoperative mortality of our hip fracture patients and established their admission serum albumin levels to see if there was any correlation between this and one-year mortality. Our results showed one-year mortality was significantly higher (p=0.0049) for those patients with a serum albumin of <35g/dl. Of the patients with low albumin, we found that there was no statistical significance between one-year mortality and source of admission (p=0.0789). Prefracture serum albumin can be used as a simple predictor of one-year mortality in patients presenting with a fractured neck of femur, thereby aiding operative planning and implant selection with a view to likely survival and possible need for revision.

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Improving Administration of Fascia-iliaca Blocks for Patients With a Fractured Neck of Femur by Clinical Audit

10.21203/rs.3.rs-502228/v1 ◽

2021 ◽

Author(s):

Isaac Okereke ◽

Sridhar Rao Sampalli

Keyword(s):

Hip Fracture ◽

Older People ◽

Femur Fracture ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Analgesic Effects ◽

Femur Fractures ◽

Anaesthetic Agents ◽

Number Of Patients ◽

Neck Of Femur Fracture

Abstract BackgroundHip fracture is the most common serious injury in older people. It is also the most common reason for older people to need emergency anaesthesia and surgery, and the commonest cause of death following an accident. A FICB is the injection of anaesthetic agents into the fascia- iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB is clinically safe and efficient and provides consistent analgesic effects irrespective of the performing doctor's experience of frailty fractures of the proximal femur.Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a neck of femur fracture between October 2018 and May 2019 was interrogated and audited. Results of this audit were discussed in the department of Trauma & Orthopaedics' and the Trust's mortality review meetings. Teaching sessions were held for doctors and filling out of the neck of femur fracture proforma to detail administration or not of FICB and a valid reason when the later occurred was encouraged. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a neck of femur fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates of administration of fascia iliaca blocks.Results We noted a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p<0.00001). There were no complications associated with the administration of FICB to patients with neck of femur fractures. ConclusionThis study showed that clinical processes could be improved through audits, staff education and by employing the use of proformas to ensure compliance.

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Adherence to guidelines regarding total hip replacement for fractured neck of femur

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0151 ◽

2016 ◽

Vol 98 (6) ◽

pp. 422-424 ◽

Cited By ~ 3

Author(s):

A Fishlock ◽

C Scarsbrook ◽

R Marsh

Keyword(s):

Hip Fracture ◽

Total Hip Replacement ◽

Hip Replacement ◽

Best Practice ◽

Treatment Strategies ◽

National Average ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Total Hip ◽

American Society

Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 – December 2013) were collected retrospectively from Scarborough Hospital’s hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.

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