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 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.

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 &lt; 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 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 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 940 Neck of Femur Fracture Management and Outcomes during COVID-19: Overview of the Results from a District General Hospital in Wales

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Waterman ◽  
U Jayaraju ◽  
J Nadimi ◽  
D Morgan
Keyword(s):  
Hip Fractures ◽  
District General Hospital ◽  
Mortality Rates ◽  
Neck Of Femur ◽  
Fourfold Increase ◽  
Retrospective Data Analysis ◽  
Fracture Management ◽  
Orthopaedic Community ◽  
Neck Of Femur Fracture ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has delivered significant challenges to the Orthopaedic community. Our study aims to assess the impact of COVID-19 on the management and outcomes of patient’s presenting with Hip Fractures to our DGH. Method Retrospective data analysis was performed on a cohort of hip fracture patients who presented to our DGH before the COVID-19 pandemic (23/03/2019 to 05/05/2019) and were compared to those who presented during the COVID-19 pandemic (23/03/2020 to 05/05/2020). Minimum follow up was 30 days postoperatively. Results 38 patients with hip fractures presented to our unit in the pre-COVID-19 period compared to 27 patients in the COVID-19 period. Total time from presentation to discharge, during COVID-19, demonstrated a 70.23% decrease when compared to the pre-COVID cohort. 30-day Mortality rates were higher in the COVID-19 cohort. Conclusions During the COVID-19 pandemic our time to theatre and discharge of hip fractures has seen an improvement, with time to discharge decreasing by 70.23%. Comparison of our mortality rates has seen a fourfold increase likely influenced by the detrimental effects of COVID-19. Further work and larger numbers are required to see the true impact of COVID-19 on the management and outcomes of hip fractures in our DGH.

scholarly journals The Neck of Femur Fracture in an Elderly Patient with Schizophrenia and Parkinsonism Managed with Dual Mobility Total Hip Replacement – A Rare Case Report

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Neetin P. Mahajan ◽  
Lalkar Laxman Gadod ◽  
Ajay S. Chandanwale ◽  
Prasanna Kumar G. S ◽  
Mrugank Narvekar ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femur Fracture ◽  
Dual Mobility Cup ◽  
Neck Of Femur ◽  
Dual Mobility ◽  
Total Hip ◽  
Femur Fractures ◽  
The Right ◽  
Neck Of Femur Fracture

Introduction: Neck of femur fractures is the most common fractures in elderly people as they present with osteoporosis. There is a higher chance of proximal femur fracture in a schizophrenic patient as there is a loss of bone mineral density due to a drug-induced increase in the level of prolactin and immobility. Patients with Parkinson’s disease were at higher risk for the development of hip fractures due to gait disturbances and instability. Case Report: A 63-year-old male patient presented with complaints of the right arm pain, swelling, deformity of the right arm, and difficulty in extending the wrist for 3 days. The patient had a history of falls and trauma to the left arm at home. X-ray right arm showed distal one-third spiral humerus fracture for which intramedullary nailing was done. X-ray of the pelvis with both hips showed right neck of femur fracture with associated greater trochanter (GT) fracture. We managed with total hip replacement using a dual mobility cup and tension band wiring for GT fracture. Postoperatively, the patient has a good range of motion at the hip. The functional outcome is good as per Harris’s hip score. Conclusion: Neck femur fractures in elderly patients with associated comorbidities such as schizophrenia and parkinsonism are best managed with total hip replacement using a dual mobility cup. It avoids the risk of dislocation in high-risk patients and prevents secondary procedures. Careful clinical and radiological examination of the pelvis is very essential even in asymptomatic patients with a history of trauma to prevent delayed diagnosis of these types of fractures in patients with schizophrenia and parkinsonism. Keywords: Neck of femur fracture, Parkinsonism, schizophrenia, dual mobility cup, total hip replacement.

scholarly journals Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

2018 ◽  
Vol 9 ◽  
pp. 215145931878223 ◽  
Author(s):  
Andrew Davies ◽  
Thomas Tilston ◽  
Katherine Walsh ◽  
Michael Kelly
Keyword(s):  
Palliative Care ◽  
Femur Fracture ◽  
Trauma Centre ◽  
Care Plan ◽  
X Rays ◽  
Neck Of Femur ◽  
Early Palliative Care ◽  
Multidisciplinary Meeting ◽  
Major Trauma Centre ◽  
Neck Of Femur Fracture

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

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