scholarly journals Resolving Controversies in Hip Fracture Care: The Need for Large Collaborative Trials in Hip Fractures

2009 ◽  
Vol 23 (6) ◽  
pp. 479-484 ◽  
Author(s):  
Mohit Bhandari ◽  
Sheila Sprague ◽  
Emil H Schemitsch
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Fracture Care

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

scholarly journals Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932095820
Author(s):  
Breanna L. Blaschke ◽  
Harsh R. Parikh ◽  
Sandy X. Vang ◽  
Brian P. Cunningham
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Financial Strain ◽  
Process Mapping ◽  
Activity Based Costing ◽  
Fracture Care ◽  
Patient Level ◽  
Reducing Costs ◽  
The Cost ◽  
Payment Models

Geriatric hip fractures are a common and costly injury. They are expected to surge in incidence and economic burden as the population ages. With an increasing financial strain on the healthcare system, payors and providers are looking toward alternative, value-based models to contain costs. Value in healthcare is the ratio of outcomes achieved over costs incurred, and can be improved by reducing cost while maintaining or improving outcomes, or by improving outcomes while maintaining or reducing costs. Therefore, an understanding of cost, the denominator of the value equation, is essential to value-based healthcare. Because traditional hospital accounting methods do not link costs to conditions, there has been little research to date on the costs of treating geriatric hip fractures over the entire cycle of care. The aim of this article is to summarize existing costing methodologies, and in particular, to review the strengths and limitations of Time-Driven Activity-Based Costing (TDABC) in orthopaedic trauma, especially as it pertains to the needs and challenges unique to hip fracture care. TDABC determines costs at the patient-level over the entire care cycle, allowing for population variability, while simultaneously identifying cost drivers that might inform risk-stratification for future alternative payment models. Through process mapping, TDABC also reveals areas of variation or inefficiency that can be targeted for optimization, and empowers physicians by focusing on costs in the control of the provider. Although barriers remain, TDABC is well-positioned to provide transparent costing and targets to improve the value of hip fracture care

scholarly journals COVID-19 pandemic and hip fractures: impact and lessons learned

2020 ◽  
Vol 1 (9) ◽  
pp. 530-540
Author(s):  
Mohamed Arafa ◽  
Samia Nesar ◽  
Hamza Abu-Jabeh ◽  
Ma Odette Remelou Jayme ◽  
Yegappan Kalairajah
Keyword(s):  
Hip Fracture ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Care Service ◽  
Health Concern ◽  
Positive Group ◽  
Fracture Care ◽  
Significant Difference ◽  
The Uk ◽  
The Impact

Aims The coronavirus disease (COVID)-19 pandemic forced an unprecedented period of challenge to the NHS in the UK where hip fractures in the elderly population are a major public health concern. There are approximately 76,000 hip fractures in the UK each year which make up a substantial proportion of the trauma workload of an average orthopaedic unit. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care service and the emerging lessons to withstand any future outbreaks. Methods Data were collected retrospectively on 157 hip fractures admitted from March to May 2019 and 2020. The 2020 group was further subdivided into COVID-positive and COVID-negative. Data including the four-hour target, timing to imaging, hours to operation, anaesthetic and operative details, intraoperative complications, postoperative reviews, COVID status, Key Performance Indicators (KPIs), length of stay, postoperative complications, and the 30-day mortality were compiled from computer records and our local National Hip Fracture Database (NHFD) export data. Results Hip fractures and inpatient falls significantly increased by 61.7% and 7.2% respectively in the 2020 group. A significant difference was found among the three groups regarding anaesthetic preparation time, anaesthetic time, and recovery time. The mortality rate in the 2020 COVID-positive group (36.8%) was significantly higher than both the 2020 COVID-negative and 2019 groups (11.5% and 11.7% respectively). The hospital stay was significantly higher in the COVID-positive group (mean of 24.21 days (SD 19.29)). Conclusion COVID-19 has had notable effects on the hip fracture care service: hip fracture rates increased significantly. There were inefficiencies in theatre processes for which we have recommended the use of alternate theatres. COVID-19 infection increased the 30-day mortality and hospital stay in hip fractures. More research needs to be done to reduce this risk. Cite this article: Bone Joint Open 2020;1-9:530–540.

scholarly journals Improving Hip Fracture Care in Ireland: A Preliminary Report of the Irish Hip Fracture Database

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Prasad Ellanti ◽  
Breda Cushen ◽  
Adam Galbraith ◽  
Louise Brent ◽  
Conor Hurson ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Preliminary Report ◽  
Older Persons ◽  
International Standards ◽  
Standards Of Care ◽  
Age Group ◽  
Web Based ◽  
Fracture Care ◽  
Orthopaedic Ward

Introduction. Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards.Methods. The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres.Results. There were 843 patients with the majority being (70%) female. The 80–89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate.Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.

scholarly journals Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
R. P. Murphy ◽  
C. Reddin ◽  
E. P. Murphy ◽  
R. Waters ◽  
C. G. Murphy ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Performance Indicators ◽  
Functional Outcomes ◽  
Best Practice ◽  
Standards Of Care ◽  
Fracture Care ◽  
Best Practice Guidelines ◽  
Improve Compliance

Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

scholarly journals 65 Fragility Fracture Network (FFN) Malaysia - A Call to Action for Better Outcome in Malaysia

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Hui Min Khor ◽  
Joon Kiong Lee ◽  
Alan Swee Hock Ch'ng ◽  
Hong Khoh ◽  
Lawrence Lee ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Fragility Fracture ◽  
Care Pathway ◽  
Fragility Fractures ◽  
Fracture Network ◽  
Asia Pacific ◽  
Secondary Fracture ◽  
Fracture Care ◽  
Rate Of Increase

Abstract Introduction The incidences of hip fractures are increasing worldwide and over 50% of all hip fractures are projected to occur in Asia. Malaysia is predicted to have the highest rate of increase in numbers of hip fracture in Asia Pacific by 2050. Despite the health and economic burden associated with fragility fractures, there is limited systematic guidance or nationwide interventions set up to address this foreseeable tsunami in Malaysia. This has called for the formation of a national Fragility Fracture Network to bring together experts from different disciplines nationally to drive policy change and improve quality of care in patients with fragility fracture. Method The Asia Pacific Regional Fragility Fracture Summit held in Singapore in May 2018 brought together representatives of regional societies from geriatrics, orthopedic, osteoporosis and rehabilitation to share key challenges in providing optimal fragility fracture care. Three clinicians from Malaysia representing three different societies in Asia Pacific who attended the summit initiated the idea of forming a national multidisciplinary network to focus on improving acute hip fracture care, post-acute care rehabilitation and secondary fracture prevention. Results After the first meeting held in June 2018 with only 4 members in Kuala Lumpur, the network has expanded to include members from 7 different states in Malaysia. This has led to the formation of the Fragility Fracture Network (FFN) Malaysia in August 2018. The key goals of the network include the development of clinical hip fracture care pathway, initiating national hip fracture registry and fracture liaison service. Conclusion FFN Malaysia serves as a platform to unite healthcare providers and policy makers in prioritizing and having co-ownership in improving fragility fracture care in the country.

HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

2014 ◽  
pp. 47-50
Author(s):  
Duy Binh Ho ◽  
Nghi Thanh Nhan Le ◽  
Maasalu Katre ◽  
Koks Sulev ◽  
Märtson Aare
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Age Groups ◽  
Femoral Fractures ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
High Risk Population ◽  
Intertrochanteric Fractures ◽  
Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

2020 ◽  
Author(s):  
Yuan Gao ◽  
Xiaojie Fu ◽  
Mingxing Lei ◽  
Pengbin Yin ◽  
Qingmei Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Subgroup Analysis ◽  
Nursing Intervention ◽  
Control Group ◽  
Study Group ◽  
Drug Compliance ◽  
Information Platform ◽  
The Difference ◽  
Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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