scholarly journals A unified multidisciplinary fragility hip fracture pilot pathway in a trauma centre in Hong Kong: One-year outcome in the acute phase

2019 ◽  
Vol 26 (2) ◽  
pp. 77-84
Author(s):  
Matthew WH Lee ◽  
KH Chui ◽  
KK Tsang ◽  
KB Lee ◽  
Wilson Li
Keyword(s):  
Hong Kong ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Acute Phase ◽  
Performance Indicator ◽  
Surgical Complication ◽  
Trauma Centre ◽  
Unplanned Readmission ◽  
Complication Rates ◽  
Fragility Hip Fracture

Introduction: The growing impact of fragility hip fracture (FHF) on the healthcare system and the society has become a major concern worldwide. A unified multidisciplinary FHF pathway from admission to rehabilitation and back to community was established in 2015. The acute phase of the pathway was put into pilot in our hospital to evaluate the outcome. Method: A designated FHF team was established in our centre since January 2015. The FHF pathway was piloted since June 2015. Patients admitted with a hip fracture resulting from fall on standing height were included. Major outcome parameters were compared in three phases: (1) before FHF team and FHF pathway (January to December 2014), (2) after FHF team but before FHF pathway (January to May 2015) and (3) after FHF team and FHF pathway (June 2015 to May 2016). Result: In phases 1, 2 and 3, 631, 263 and 634 patients were included, respectively. From phases 1 to 3, the average key performance indicator (KPI) has improved from 49.2% to 65.8% to 70.0% significantly; average acute length of stay (days) has improved from 13.7 to 13.4 to 11.3 significantly; total surgical complication rates have improved from 6.2% to 7.6% to 5.8%. The 30-day mortality rate and the unplanned readmission rate (within 28 days) have remained below 2.7% and 2.2%, respectively. Conclusions: Implementation of an FHF pathway can form a multidisciplinary platform that can improve the standard of care and outcome for our FHF patients in terms of KPI and also length of stay. New knowledge added by this study: A newly designed and implemented fragility hip fracture pathway in our centre as a pilot with the results evaluated. Implications for clinical practice or policy: With the increasing elderly population in Hong Kong and globally, there is a need to design and implement a fragility hip fracture (FHF) pathway to improve the care and effectiveness for FHF patients.

scholarly journals Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215145932110066
Author(s):  
Naoko Onizuka ◽  
Lauren N. Topor ◽  
Lisa K. Schroder ◽  
Julie A. Switzer
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Healthcare System ◽  
Perioperative Complications ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Surgical Care ◽  
Admission Rate ◽  
System Response ◽  
Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

scholarly journals From ER to OR: Results After Implementation of Multidisciplinary Pathway for Fragility Hip Fractures at a Level I Trauma Center

2020 ◽  
Vol 11 ◽  
pp. 215145932092738
Author(s):  
Kenoma Anighoro ◽  
Carla Bridges ◽  
Alexander Graf ◽  
Alexander Nielsen ◽  
Tannor Court ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Trauma Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Blood Products ◽  
Total Blood ◽  
Fragility Hip Fracture ◽  
Level I

Introduction: Hip fractures are one of the most common indications for hospitalization and orthopedic intervention. Fragility hip fractures are frequently associated with multiple comorbidities and thus may benefit from a structured multidisciplinary approach for treatment. The purpose of this article was to retrospectively analyze patient outcomes after the implementation of a multidisciplinary hip fracture pathway at a level I trauma center. Materials and Methods: A retrospective review of 263 patients over the age of 65 with fragility hip fracture was performed. Time to surgery, hospital length of stay, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists, complication rates, and other clinical outcomes were compared between patients treated in the year before and after implementation of a multidisciplinary hip fracture pathway. Results: Timing to OR, hospital length of stay, and complication rates did not differ between pre- and postpathway groups. The postpathway group had a greater CCI score (pre: 3.10 ± 3.11 and post: 3.80 ± 3.18). Fewer total blood products were administered in the postpathway group (pre: 1.5 ± 1.8 and post: 0.8 ± 1.5). Discussion: The maintenance of clinical outcomes in the postpathway cohort, while having a greater CCI, indicates the same quality of care was provided for a more medically complex patient population. With a decrease in total blood products in the postpathway group, this highlights the economic importance of perioperative optimization that can be obtained in a multidisciplinary pathway. Conclusion: Implementation of a multidisciplinary hip fracture pathway is an effective strategy for maintaining care standards for fragility hip fracture management, particularly in the setting of complex medical comorbidities.

scholarly journals Prognostic factors related to ambulation deterioration after 1-year of geriatric hip fracture in a Chinese population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ronald Man Yeung Wong ◽  
Jianghui Qin ◽  
Wai Wang Chau ◽  
Ning Tang ◽  
Chi Yin Tso ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Old Age ◽  
Early Discharge ◽  
Fragility Hip Fracture ◽  
Post Surgery ◽  
Increased Risk ◽  
Male Patients ◽  
Old Age Homes

AbstractThe objective of this study was to investigate the prognostic factors predicting the ambulation recovery of fragility hip fracture patients. 2286 fragility hip fracture patients were collected from the Fragility Fracture Registry in Hong Kong. Predictive factors of ambulation deterioration including age, gender, pre-operation American Society of Anesthesiologists grade, pre-fracture mobility, delay to surgery, length of stay, fracture type, type of surgery, discharge destination and complications were identified. Patients with outdoor unassisted and outdoor with aids ambulatory function before fracture had 3- and 1.5-times increased risk of mobility deterioration, respectively (Odds Ratio (OR) = 2.556 and 1.480, 95% Confidence Interval (CI) 2.101–3.111 and 1.246–1.757, both p < 0.001). Patients living in old age homes had almost 1.4 times increased risk of deterioration when compared to those that lived in their homes (OR = 1.363, 95% CI 1.147–1.619, p < 0.001). The risk also increased for every 10 years of age (OR = 1.831, 95% CI 1.607–2.086, p < 0.001). Patients in the higher risk ASA group shows a decreased risk of ambulation deterioration compared to those in lower risk ASA group (OR = 0.831, 95% CI 0.698–0.988, p = 0.038). Patients who suffered from complications after surgery did not increased risk of mobility decline at 1-year post-surgery. Delayed surgery over 48 h, delayed discharge (> 14 days), early discharge (less than 6 days), and length of stay also did not increased risk of mobility decline. Male patients performed worse in terms of their mobility function after surgery compared to female patients (OR = 1.195, 95% CI 1.070–1.335, p = 0.002). This study identified that better premorbid good function, discharge to old age homes especially newly institutionalized patients, increased age, lower ASA score, and male patients, correlate with mobility deterioration at 1-year post-surgery. With the aging population and development of FLS, prompt identification of at-risk patients should be performed for prevention of deterioration.

Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre

2013 ◽  
Vol 8 (1-2) ◽  
Author(s):  
Nicole Williams ◽  
Ben M. Hardy ◽  
Seth Tarrant ◽  
Natalie Enninghorst ◽  
John Attia ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Major Trauma ◽  
Trauma Centre ◽  
Fracture Incidence ◽  
Hip Fracture Incidence ◽  
Major Trauma Centre

Older Chinese patients with fragility hip fracture in Hong Kong: calling for focused ortho-geriatric co-care

2019 ◽  
Vol 3 ◽  
pp. 19-19
Author(s):  
Hon-Ming Ma ◽  
Qi Ding ◽  
Louis Wing-Hoi Cheung ◽  
Simon Kwoon-Ho Chow ◽  
Kwok-Sui Leung
Keyword(s):  
Hong Kong ◽  
Hip Fracture ◽  
Chinese Patients ◽  
Fragility Hip Fracture ◽  
Older Chinese

scholarly journals Integrated Fragility Hip Fracture Program: A Model for High Quality Care

2020 ◽  
Vol 15 (8) ◽  
pp. 461-467 ◽  
Author(s):  
Jensa C Morris ◽  
Anne Moore ◽  
Joseph Kahan ◽  
Marc Shapiro ◽  
Jinlei Li ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Clinical Outcomes ◽  
Hip Fractures ◽  
Quality Care ◽  
Multidisciplinary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Fragility Hip Fracture

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality among elderly patients. Coordinated multidisciplinary care is required to optimize medical outcomes. OBJECTIVE: To determine the effect of the implementation of standardized, evidence-based protocols on clinical outcomes and mortality in patients with fragility hip fractures. INTERVENTIONS: A multidisciplinary group was convened to define best practices in fragility hip fracture care and implement a fragility hip fracture clinical protocol at Yale-New Haven Hospital. Clinical outcomes in 2015, prior to program initiation, were compared with 2018, after the program was well established. MAIN OUTCOMES AND MEASURES: Measured outcomes included 30-day mortality, blood transfusion utilization, adverse effects of drugs, venous thromboembolic complications, sepsis, myocardial infarction, mechanical surgical fixation complications during the index admission, length of stay, 30-day readmission, unexpected return to the operating room (OR) and time to the OR. RESULTS: The implementation of the Integrated Fragility Hip Fracture Program was associated with significant reductions in 30-day mortality from 8.0% in 2015 to 2.8% in 2018 (P = .001). Significant reductions were also seen in use of blood transfusions (46.6% to 28.1%; P < .001), adverse effects of drugs (4.0% to 0%; P < .001), length of stay (5.12 to 4.47 days; P = .004), unexpected return to the OR (5.1% to 0%; P < .001), and time to the OR <24 hours (41.8% to 55.0%, P = .001). CONCLUSIONS: An Integrated Fragility Hip Fracture Program using multidisciplinary care, physician and nursing engagement, evidence-based protocols, data tracking with feedback, and accountability can reduce mortality and improve clinical outcomes in patients with hip fractures.

scholarly journals Integrated Hip Fracture Care Pathway (IHFCP): reducing complications and improving outcomes

2021 ◽  
Author(s):  
L Heyzer ◽  
R Ramason ◽  
JADC Molina ◽  
WWL Chan ◽  
YL Chen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Outcome Measures ◽  
Average Length ◽  
Care Pathway ◽  
Post Discharge ◽  
Fracture Care ◽  
Fragility Hip Fracture ◽  
Average Length Of Stay ◽  
Process And Outcome

Introduction: Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients. Methods: A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline. Results: The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%. Conclusion: The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients’ functional status and improved their overall outcome.

scholarly journals P-OGC82 Length of stay in hospital as a prognostic tool for post-esophagectomy survival

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Catherine Jenn Yi Cheang ◽  
Pradeep Patil
Keyword(s):  
Overall Survival ◽  
Length Of Stay ◽  
Performance Indicator ◽  
Statistical Significance ◽  
Care Practice ◽  
Complication Rates ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference

Abstract Background Length of stay (LOS) after oesophagectomy is an indicator of efficiency of patient care, practice style, complication rates and their management. Median LOS in specialist centres is 10 to 12 days. The desired LOS as a quality performance indicator (QPI) has recently been reduced from 21 days to 14 days in our country. The aim of this study was to see if this change in LOS could be validated by differences in long term outcomes. Methods A total of 110 consecutive patients who underwent esophagectomy for cancer between 2011 and 2020 were included in this study. We compared the statistical significance in overall survival of patients with LOS 14 days and 21 days as two separate datasets. Overall survival (OS) in months was calculated from date of surgery to death or otherwise censored. 4 patients who died in hospital were excluded. Statistical analysis was conducted using IBM SPSSv25. Results 110 consecutive patients were included in this study. The median postoperative stay for all patients was 18 days with an interquartile range of 14 to 26 days. Kaplan Meier survival comparison with Log Rank of OS with LOS 21 days showed no difference in survival between patients with LOS ≤ 21 days and LOS &gt; 21 days (p = 0.487). A similar comparison showed a statistically significant difference in survival in patients with LOS≤ 14 days and LOS &gt; 14 days (p = 0.034), with a mean survival (months) of 80.9 and 60.2 respectively. Conclusions LOS after surgery is a marker of patient health, care efficiency and uncomplicated recovery. No clear LOS with patient benefits has been defined in the past. A LOS of 14 days after oesophagectomy in our cohort is interestingly an indicator and predictor of long-term survival. Further subgroup analysis of patient and tumour characteristics are being carried out to see if we can predict patients who can be discharged in less than 14 days. These characteristics can then be used to predict and study long term survival after oesophagectomy.

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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