scholarly journals 1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Linardatou Novak ◽  
B Davies ◽  
A Bacon ◽  
A MacDowell
Keyword(s):  
Length Of Stay ◽  
Femur Fracture ◽  
Average Length ◽  
Multidisciplinary Care ◽  
District General Hospital ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Neck Of Femur Fracture

Abstract Aim We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020. Method We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates. Results We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p < 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14). Conclusions There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.

The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

2020 ◽  
pp. 112070002097202
Author(s):  
Hiba Khan ◽  
Al-Achraf Khoriati ◽  
Stefan Lazic ◽  
Jack Navein ◽  
Ritesh Sharma ◽  
...  
Keyword(s):  
High Risk ◽  
Femur Fracture ◽  
Mortality Rates ◽  
Time Frame ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Femur Fractures ◽  
American Society ◽  
Neck Of Femur Fracture ◽  
The Impact

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

scholarly journals 208 Assessment of The Impact Of COVID-19 On the Management of Patients with Neck of Femur Fractures in A Major Trauma Center In Wales

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Solari ◽  
Z Ansar
Keyword(s):  
Length Of Stay ◽  
Operative Treatment ◽  
Major Trauma ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Neck Of Femur ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
The Impact

Abstract Introduction Neck of femur (NOF) fractures form a significant proportion of trauma. Especially since they do not benefit from COVID-19 social isolation policies. Surgery and hospital admissions present risks to patients during the COVID-19 pandemic. Method Retrospective analysis of all NOF fractures from 24/3/20 to 26/6/20 in Morriston Hospital. Directly compared with 2019, allowing assessment of COVID-19’s impact. Results 179 NOF fractures were admitted, 158 had an operation. Increased from 127 patients in 2019. Average time to surgery increased from 39 to 67 hours. There were operation delays for 98 patients, and non-operative treatment increased from 2 to 21 patients. Prompt orthogeriatric reviews completed in 80.4% patients in 2020, up from 72.5%. Prompt physiotherapy review increased from 66.9% to 74.6%. Mortality remained similar at 8.6% (2019) and 8.5% (2020). Average length of stay reduced; 17.4 to 11 days in 2020. Conclusions 2020 saw increased waits for operations. There was reduction in length of stay and improved promptness of orthogeriatric and physiotherapy reviews. Increased non-operative treatment in 2020, reflecting decisions about risks and benefits of surgery in the pandemic. Mortality remained stable. This department improved some aspects of care, potentially due to pressures of COVID-19 heightening awareness of patient's needs.

scholarly journals 1365 Analysis of Outcomes Pre- and Post-Physiotherapy Protocol for Centenarian Patients Presenting with Neck of Femur Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shaladi ◽  
I Abdelkarim ◽  
J Kitson
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Inpatient Mortality ◽  
Neck Of Femur ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Improved Outcomes ◽  
Future Management

Abstract Aim The number of centenarians has quadrupled over the last 2 decades with an increase in the number presenting with proximal femur fractures. Very little is known about mortality and morbidity in this age group. There is a subjective assumption that they are too frail and may not do well with surgery. This audit aims to outline improved outcomes of surgery in centenarian patients with NOF fractures following dedicated modified physiotherapy intervention. Method Data reviewing centenarian NOF outcomes over a two-year period (2015-2016) was compared with outcomes following a dedicated post-operative physiotherapy trust protocol for centenarian NOF patients. 16 patients (15 female, 1 male) from Jan 2017- August 2019 were identified. Data was analysed for patient demographics, surgical details including anaesthesia, post-operative complications, physiotherapy outcomes and mortality. Results 10 patients had dynamic hip screws and 6 patients had hemiarthroplasties. Inpatient mortality was 0% compared to previous audit of 8.3%. The average length of stay had reduced from 23.3 days in previous audit to 18.5 days in current. 82% of patients could transfer with frame in the post-operative period. Conclusions Positive surgical outcomes are demonstrated even in centenarians particularly when given tailored post-operative physiotherapy with reduced length of stay, mortality, and high levels of physiotherapy compliance. Comparisons with younger elderly patients will help guide future management.

scholarly journals 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 ◽  
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.

scholarly journals The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

2020 ◽  
Vol 1 (11) ◽  
pp. 669-675
Author(s):  
Alex E. Ward ◽  
Daniel Tadross ◽  
Fiona Wells ◽  
Lawrence Majkowski ◽  
Umna Naveed ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Bacterial Pneumonia ◽  
Femur Fracture ◽  
Kidney Injury ◽  
High Rate ◽  
Neck Of Femur ◽  
Increased Risk ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

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

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.

scholarly journals 1414 The Impact Of COVID-19 On Individuals with Neck of Femur Fracture in The United Kingdom: A Systematic Review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Andritsos ◽  
O Thomas ◽  
S Pallikadavath ◽  
S Sambhwani ◽  
S Kirmani
Keyword(s):  
Systematic Review ◽  
Femur Fracture ◽  
Meta Analysis ◽  
Case Series ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Level 3 ◽  
The Uk ◽  
Neck Of Femur Fracture ◽  
The Impact

Abstract Aim All Neck of Femur fracture patients have a significant 30 – day mortality despite efforts to improve their outcomes. Incidence of NOF cases remained high during the pandemic in the UK and as a result numerus cases were complicated with SARS-CoV-2 infection. We performed a systematic review and meta-analysis of all UK published studies related to NOF fractures and 30-day mortality outcomes during the COVID 19 pandemic. Method A systematic review and meta-analysis was performed and reported as per the PRISMA checklist. Two reviewers independently searched on Medline for UK studies that were published between 1stof March 2020 and 1stof November 2020. Outcomes compared were 30-day mortality, time to surgery and anaesthetic risk. Results A total of 5 articles were included in our study. These studies were all case series with evidence level 3 or 4. A total of 286 patients complicated with COVID infection with a range of 30-day mortality 30.5%-50%. OR 6.02(95CI: 4.10-8.85), Chi24.82, I2 58%. Increased time to surgery due to Coronavirus related delays was also noted for the majority of studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip fracture score) failed to accurately predict the mortality risk. Conclusions Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.

The impact of COVID-19 on 30-day mortality in patients with neck of femur fractures

2020 ◽  
Vol 1 (7) ◽  
pp. 326-329 ◽  
Author(s):  
James E. Archer ◽  
Siddhant Kapoor ◽  
Danielle Piper ◽  
Abdulrahman Odeh
Keyword(s):  
Hip Fracture ◽  
Femur Fracture ◽  
Early Mobilization ◽  
Early Assessment ◽  
Optimal Care ◽  
Neck Of Femur ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims The COVID-19 pandemic presents a significant threat to patients with neck of femur fractures. The 30-day mortality for these patients has gradually been reducing in the UK due to a multitude of inputs aimed at improving their outcomes. We provided an early assessment of 30-day mortality in neck of femur fracture patients who contracted COVID-19. Methods We identified 18 patients who were admitted from three acute hospital sites who underwent an operation for a neck of femur fracture and were diagnosed with COVID-19 between 25 March and 25 April 2020. We collected information on their age, American Association of Anesthesiologists (ASA) grade, diagnosis, surgical procedure, complications, and 30-day mortality. Results Our study identified 18 patients who were all diagnosed with a positive swab result during the postoperative period. Female patients made up two-thirds of the patient cohort and the mean age of patients was 82 years (55 to 101). In all, ten patients sustained intracapsular fractures with eight sustaining extracapsular fractures. The 30-day mortality in this group of patients was 22.2% as compared to 4% 30-day mortality in those without COVID-19. Conclusion Our results show a 30-day mortality of 22.2%, which is higher than the national average provided by the 2019 National Hip Fracture Database report. However, while 30-day mortality has increased in those patients with COVID-19, this should not impact upon the provision of hip fracture surgery as it provides significant benefits to the patient such as pain relief and early mobilization. However, the information presented in this study should form an important part of the informed consent process for surgery. A multidisciplinary approach is crucial in ensuring optimal care for this complex patient group. Cite this article: Bone Joint Open 2020;1-7:326–329.

scholarly journals New drug, new problem: do hip fracture patients taking NOACs experience delayed surgery, longer hospital stay, or poorer outcomes?

2019 ◽  
Vol 30 (6) ◽  
pp. 799-804 ◽  
Author(s):  
George JM Hourston ◽  
Michael P Barrett ◽  
Wasim S Khan ◽  
Madhavi Vindlacheruvu ◽  
Stephen M McDonnell
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Linear Regression Analysis ◽  
Neck Of Femur ◽  
Prolonged Length ◽  
Delayed Surgery ◽  
Time To Surgery ◽  
Femur Fractures

Introduction: Neck of femur fractures are common in the comorbid, often anticoagulated, elderly. Non-vitamin K antagonist oral anticoagulants (NOACs) may affect patient outcomes. We aimed to evaluate whether hip fracture patients admitted on warfarin or NOAC therapy were at risk of operative delay, prolonged length of stay, or increased mortality. Methods: We collected data for 845 patients admitted to our centre between October 2014 and December 2016. Multivariable linear regression analysis was performed to test the association between warfarin and NOAC therapy on time to surgery and length of stay. Variables in the regression model were age, sex, admission AMTS, pre-fracture mobility, ASA score, fracture type, and operation type. Fisher’s exact test was used to evaluate whether warfarin or NOAC therapy delayed surgery beyond 36 or 48 hours, or decreased 30-day, 6-month, or 12-month survival. Results: Time to surgery was delayed in anticoagulated patients ( p = 0.028). NOAC therapy was independently associated with increased time to surgery beyond 36 hours ( p = 0.001), although not beyond 48 hours ( p = 0.355), whereas warfarin therapy was not associated with either. Anticoagulation did not increase length of stay ( p = 0.331). Warfarin therapy significantly reduced 30-day survival ( p = 0.007), but NOAC therapy did not ( p = 0.244). Neither warfarin nor NOAC therapy affected further survival. Conclusions: NOAC therapy delays time to surgery beyond the NHS England ‘Best Practice Tariff’ in hip fracture patients. We aim to prospectively investigate long-term outcomes. Without a NOAC antidote, policy must change to ensure time-appropriate surgery for patients on NOACs. Preoperative involvement of the haematology team is essential.

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