scholarly journals Does a Dedicated Unit for the Treatment of Hip Fractures Improve Acute Outcomes?

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Al-achraf Khoriati ◽  
Wael Dandachli ◽  
Rupinderbir Deol ◽  
Nicholas de Roeck
Keyword(s):  
Nursing Home ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Time To Surgery ◽  
Trauma Unit ◽  
Group 2 ◽  
Inpatient Length Of Stay ◽  
Group 1

The aim of this study is to establish whether management of patients in a unit dedicated to the treatment of hip fractures improves acute outcomes. We prospectively studied 300 patients with hip fractures in two separate groups. Patients in Group 1 were operated on in a mixed trauma unit and recovered in a traditional trauma ward. Patients in Group 2 were operated on in dedicated theatres and recovered in a unit which catered exclusively for hip fractures. The ages, ASA grades, and type of procedure performed in the two groups were comparable. The 30-day mortality rate in Group 2 was 9% as opposed to 12% in Group 1 (P=0.34). The inpatient length of stay was significantly lower in Group 2 (18 days versus 25 days; P=0.0002) and so was the time taken to operate (28 hours versus 34 hours; P=0.04). A greater percentage of patients in Group 2 were discharged home as opposed to a nursing home (75% versus 67%). This difference approached significance (P=0.18). We conclude that prioritisation and prompt management of patients with hip fractures in a dedicated unit significantly improve time to surgery and significantly decrease length of stay.

The value of ring-fenced beds in elective lower limb arthroplasty

2019 ◽  
Vol 80 (7) ◽  
pp. 405-409
Author(s):  
Matthew Green ◽  
Eleanor Tung ◽  
Oday Al-Dadah
Keyword(s):  
Length Of Stay ◽  
Prosthetic Joint Infection ◽  
Lower Limb ◽  
Joint Infection ◽  
Admission Rates ◽  
Prosthetic Joint ◽  
Before And After ◽  
Group 2 ◽  
Inpatient Length Of Stay ◽  
Group 1

Background:Infection is a serious complication of prosthetic joint arthroplasty, associated with high rates of morbidity resulting in further surgical intervention and prolonged inpatient hospital admission. Rates of prosthetic joint infection have been reported as 1.5–2.5% following lower limb arthroplasty. This study compared infection rates in patients receiving primary hip and knee joint replacements before and after implementation of ring-fenced beds.Methods:Retrospective study of all patients undergoing primary total hip replacement and total knee replacement from April 2013 to February 2014. Group 1 included pre-ring-fencing patients, group 2 included post-ring-fencing patients.Results:The overall infection rate pre-ring-fencing was 6.3% (n=8). This reduced to 2.7% (n=3) post-ring-fencing. The mean inpatient length of stay for group 1 was 6 days vs 4 days for group 2.Conclusions:Ring-fencing beds for patients undergoing elective lower limb arthroplasty significantly reduced rates of prosthetic joint infection and inpatient length of stay.

scholarly journals Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

2021 ◽  
Vol 12 ◽  
pp. 215145932110096
Author(s):  
Christina Polan ◽  
Heinz-Lothar Meyer ◽  
Manuel Burggraf ◽  
Monika Herten ◽  
Paula Beck ◽  
...  
Keyword(s):  
Nursing Home ◽  
Elderly Patients ◽  
Proximal Femur ◽  
Minor Trauma ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Number Of Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

scholarly journals Management of a pediatric burn center during the covid-19 pandemic

2021 ◽  
Author(s):  
Ahmet Erturk ◽  
Sabri Demir ◽  
Can İhsan Oztorun ◽  
Elif Emel Erten ◽  
Dogus Guney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Body Surface Area ◽  
Center Staff ◽  
Staff Members ◽  
Burn Center ◽  
History Of ◽  
Group 2 ◽  
Travel Abroad ◽  
Pcr Test ◽  
Group 1

Abstract The aim of this study was to evaluate the results of an algorithm that was created to prevent coronavirus disease-2019 (COVID-19) transmission during the management of children with burns in a tertiary pediatric burn center. Children admitted to the burn center between May 2020 and November 2020 were prospectively evaluated for cause, burn depth, total body surface area (TBSA), length of stay, symptoms suggesting COVID-19, suspicious contact history, history of travel abroad, and COVID-19 polymerase chain reaction (PCR) test results. Patients were divided into two groups: unsuspected (Group 1) and suspected (Group 2), depending on any history of suspicious contact, travel abroad, and/or presence of symptoms. A total of 101 patients were enrolled in the study, which included 59 boys (58.4%) and 42 girls (41.6%). Group 1 included 79 (78.2%) patients, and Group 2 consisted of 22 (21.8%) patients. The most common cause of the burns was scald injuries (74.2%). The mean age, TBSA, and length of stay were 4.5 years, 12.0%, and 13.2 days, respectively. Four patients (3.9%) had a positive PCR test (two patients in each group). Comparing groups, males were more commonly found in Group 2 (p=0.042), but no differences were found for the other variables. No patients or burn center staff members developed COVID-19 during the course of hospitalization. In conclusion, every child should be tested for COVID-19 upon admission to a burn unit, and a modified algorithm should be constructed for the handling and management of pediatric burn patients.

scholarly journals Short versus standard PFN outcome analysis in unstable intertrochantric fracture

2018 ◽  
Vol 4 (5) ◽  
pp. 747
Author(s):  
Pravin Kumar Jangde ◽  
Anant Kumar Singh
Keyword(s):  
Hip Fractures ◽  
Trochanteric Fracture ◽  
The Elderly ◽  
Outcome Analysis ◽  
Femoral Canal ◽  
Femoral Nail ◽  
Group 2 ◽  
One Year ◽  
Group B ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Hip fractures in the elderly are frequent. Intertrochanteric hip fractures account for approximately half of all hip fractures in the elderly; of these, from 50% to 60% are classified as unstable. In our study we tried to compare outcome of unstable trochantric fracture in terms length of PFN (180 vs 240 mm).</p><p class="abstract"><strong>Methods:</strong> 80 patients of unstable trochanteric fracture were randomly allotted to 2 groups who were treated with closed reduction and internal fixation with proximal femoral nail of size 180 mm(group A) and 240mm (group B). Patients in both the group were compared right from the fracture configuration till the one year post-operative period.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the study of 80 patients there were 18 males (45%) and 22 females (55%) in group 1, and 23 male (57%) and 17 female (42.5%) in group 2. Group 1 patient had a better range of movements than group 2. Femoral canal impingement was present in 6 (15%) of patients of group 1 and 28(70%) patients of group 2 showed femoral canal impingement.</p><p class="abstract"><strong>Conclusions:</strong> There are very few studies which compare the length of PFN to the outcome. The standard PFN group presented with complications like femoral nail impingement and hence more thighs pain and less range of movements even after one year of follow up. We conclude that for Indian group of population who have a relatively short femora gives a better result with a shorter length implant.</p>

Impact of Length of Stay on Functional Outcomes of TBI Patients

2005 ◽  
Vol 71 (11) ◽  
pp. 920-930 ◽  
Author(s):  
M.L. Hawkins ◽  
F.D. Lewis ◽  
R.S. Medeiros
Keyword(s):  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Care ◽  
Average Length ◽  
Functional Independence ◽  
Average Length Of Stay ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

scholarly journals Ultrasound scanning of RIF pain may increase time to surgery and inpatient length of stay

2013 ◽  
Vol 11 (8) ◽  
pp. 713
Author(s):  
Collins Ekere ◽  
Elisabeth Royston ◽  
Christopher Arrowsmith ◽  
Chaitanya Mehta ◽  
Robert Talbot
Keyword(s):  
Length Of Stay ◽  
Ultrasound Scanning ◽  
Time To Surgery ◽  
Inpatient Length Of Stay

Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol

2020 ◽  
pp. 112070002091933
Author(s):  
Anthony V Christiano ◽  
Hannah C Elsevier ◽  
Salman Sarker ◽  
George Agriantonis ◽  
David Joseph ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Safety Net ◽  
Management Service ◽  
Protocol Implementation ◽  
Time To Surgery ◽  
Number Of Patients ◽  
Safety Net Hospital ◽  
Urban Safety

Introduction: standardised protocols for the care of geriatric hip fractures demonstrate improved patient outcomes with decreased cost. The purpose of this study is to evaluate outcomes of a standardised hip fracture protocol at an urban safety-net hospital. Methods: All trauma patients presenting to our urban safety-net hospital are included in a trauma database and inpatient outcomes recorded. A hip fracture protocol was introduced at our institution in 2015, which depended on admission to a monitored setting due to the absence of a geriatric co-management service. The database was queried to identify patients surgically treated for a geriatric hip fracture in the 3 years prior to protocol implementation (2012–2014) and patients treated in the 3 years following protocol implementation (2016–2018). Demographics, time to surgery, inpatient complications, and length of stay were compared between groups. Results: A total of 633 patients treated operatively for isolated hip fractures were identified, 262 patients in the 2012–2014 pre-protocol cohort, and 371 patients in the 2016–2018 protocol cohort. Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p < 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days ( p = 0.054). The complication rate fell from 23% to 4% ( p < 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days ( p = 0.045). Conclusions: A hip fracture protocol including admission to a monitored setting can be effectively implemented at an urban safety-net hospital where geriatric co-management is not available. This resulted in a decrease in complications and length of stay. Additional interventions are required to decrease average time to surgery below 36 hours.

scholarly journals 295 Characteristics of Older Hip Fracture Adults Admitted to a Dublin Hospital

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Niamh Maher ◽  
Georgina Steen ◽  
Nessa Fallon ◽  
Claire O Carroll ◽  
Máire Rafferty ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Average Length ◽  
Dublin Hospital ◽  
Fracture Repair ◽  
Mortality And Morbidity ◽  
Negative Effect ◽  
Bone Protection

Abstract Background Hip fractures are common in older adults and are associated with increased mortality and morbidity resulting in medical and socioeconomic burden for healthcare system and patient alike. Methods A retrospective study was conducted on patients admitted to a Dublin hospital for hip fracture repair between October 2018 and February 2019. Data on sociodemographic characteristics such as; gender; age; pre-admission residence; fracture history; bone protection medication use; pre-fracture mobility; discharge mobility and destination; length of stay and mortality rate was collected. Results 50 patients admitted between 01/10/19 and 31/01/2019. 2:1 female to male. Average age 78 ranging from 48-93. 88% admitted from home. 44% had previous fractures. Vertebral (36%), wrist (23%) and pelvic (23%) most common fractures. 27% of these were on bone protection medication on admission. 41% were taking Calcium and Vit D or Vitamin D only. 70% of participants were independently mobile pre-fracture. 94% required some form of mobility aid on discharge. The average length of stay was 32 days ranging from 2 to 160 days. 38% went home whilst 36% were discharged to rehabilitation. 88% were discharged on bone protection medication - 70% received IV Zoledronic acid as inpatients, 14% commenced Prolia 6 monthly injections and 4% on oral bisphosphonates. Mortality rate was 6% Conclusion Hip fractures have a negative effect on a person’s mobility. Whilst many guidelines for the assessment and treatment of osteoporosis recommend intervention be considered in men and women who have sustained a fragility fracture, it is clear from this study that an osteoporosis care gap exists and further work is required to better identify, assess and treat patients following their first fracture in the hope of reducing further fractures, particularly hip and vertebral fractures.

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