scholarly journals The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

2020 ◽  
Vol 11 ◽  
pp. 215145932091084
Author(s):  
Azeem Tariq Malik ◽  
Safdar N. Khan ◽  
Thuan V. Ly ◽  
Laura Phieffer ◽  
Carmen E. Quatman
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Trauma Centers ◽  
Recent Discussion ◽  
Readmission Rates ◽  
Policy Makers ◽  
Bundled Payment ◽  
Challenges And Opportunities ◽  
Financial Disincentives ◽  
Joint Arthroplasties

Introduction: With growing popularity and success of alternative-payment models (APMs) in elective total joint arthroplasties, there has been recent discussion on the probability of implementing APMs for geriatric hip fractures as well. Significance: Despite the growing interest, little is known about the drawbacks and challenges that will be faced in a stipulated “hip fracture” bundle. Results: Given the varying intricacies and complexities of hip fractures, a “one-size-fits-all” bundled payment may not be an amenable way of ensuring equitable reimbursement for participating physicians and hospitals. Conclusions: Health-policy makers need to advocate for better risk-adjustment methods to prevent the creation of financial disincentives for hospitals taking care of complex, sicker patients. Hospitals participating in bundled care also need to voice concerns regarding the grouping of hip fractures undergoing total hip arthroplasty to ensure that trauma centers are not unfairly penalized due to higher readmission rates associated with hip fractures skewing quality metrics. Physicians also need to consider the launch of better risk-stratification protocols and promote geriatric comanagement of these patients to prevent occurrences of costly adverse events.

Clostridium difficile colitis in patients undergoing surgery for hip fractures: an analysis of 17,474 patients

2019 ◽  
Vol 30 (1) ◽  
pp. 22-32
Author(s):  
Azeem Tariq Malik ◽  
Carmen E Quatman ◽  
Laura S Phieffer ◽  
Thuan V Ly ◽  
Safdar N Khan
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Clostridium Difficile ◽  
Hip Fractures ◽  
Healthcare Utilisation ◽  
Open Reduction Internal Fixation ◽  
Fracture Repair ◽  
Bundled Payment ◽  
Factors Associated ◽  
Incidence Risk

Background: We compiled evidence from a large national surgical database to identify the incidence, risk factors and postoperative impact of Clostridium difficile infection (CDI) in patients undergoing hip fracture repair. Methods: We identified 17,474 patients who underwent hip fracture repairs in 2015 using the ACS-NSQIP database. Interventions studied were open reduction/Internal fixation, total hip arthroplasty or hemiarthroplasty being performed for traumatic hip fractures. Outcomes studied were incidence, preoperative and postoperative risk factors for occurrence of CDI were studied using descriptive and statistical analysis. Results: A total of 92 patients (0.53%) developed CDI within 30 days of the operation. Following adjustment using multi-variate logistic regression, preoperative and hospital-associated factors associated with development of CDI were smoking (OR 1.75 [95% CI 1.03–2.99]), hypertension (OR 1.70 [95% CI 1.01–2.85]), hyponatraemia (OR 1.65 [95% CI 1.04–2.63]), prior systemic inflammatory response syndrome (SIRS) (OR 2.18 [95% CI 1.32-3.59]) and a length of stay >7 days (OR 1.98 [95% CI 1.11–3.53]. Postoperative factors associated with occurrence of CDI were occurrence of a deep surgical site infection (SSI) (OR 5.89 [95% CI 1.31–26.6]), a stay in the hospital >30 days (OR 6.56 [95% CI 2.56–16.9]) and unplanned reoperations (OR 2.78 [95% CI 1.29–5.99]). Conclusion: As we move toward an era of bundled-payment models, identification of risk factors associated with the occurrence of postoperative complications, such as CDI, will help curb excess healthcare utilisation and costs associated with the management of this complication.

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 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 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.

scholarly journals Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
pp. 215145932098629 ◽  
Author(s):  
Yulia Bugaevsky ◽  
Yochai Levy ◽  
Avital Hershkovitz ◽  
Irena Ocheretny ◽  
Adaya Nissenholtz ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Functional Independence ◽  
Functional Improvement ◽  
Orthopedic Department ◽  
Successful Recovery

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

scholarly journals A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

2021 ◽  
Author(s):  
Rebecka Ahl ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Gabriel Sjölin ◽  
Maximilian Peter Forssten ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Beta Blocker ◽  
Observational Cohort Study ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Fracture Surgery

Abstract Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

scholarly journals Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Pincus ◽  
Jessica Widdifield ◽  
Karen S. Palmer ◽  
J. Michael Paterson ◽  
Alvin Li ◽  
...  
Keyword(s):  
Time Series ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Wait Times ◽  
Hospital Funding ◽  
Hip Fracture Surgery ◽  
After Hours ◽  
Fracture Surgery

Abstract Background Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Methods This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends. Results The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy. Conclusions We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.

scholarly journals Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110162
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Syed Tahmid ◽  
Roberto Hernandez-Irizarry ◽  
Jerad Allen
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Depressive Disorders ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Non Union ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

scholarly journals Too Cool? Hip Fracture Care and Maintaining Body Temperature

2020 ◽  
Vol 11 ◽  
pp. 215145932094947
Author(s):  
James Arkley ◽  
Suhib Taher ◽  
Ján Dixon ◽  
Gemma Dietz-Collin ◽  
Stacey Wales ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Temperature Control ◽  
Functional Outcomes ◽  
Surgical Site Infections ◽  
Fragility Fractures ◽  
Perioperative Period ◽  
Readmission Rates ◽  
Comprehensive Review ◽  
Fracture Care ◽  
Increase Risk

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

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