The association between hospital case volume and in-hospital and one-year mortality after hip fracture surgery

2020 ◽  
Vol 102-B (10) ◽  
pp. 1384-1391
Author(s):  
Seokha Yoo ◽  
Eun Jin Jang ◽  
Junwoo Jo ◽  
Jun Gi Jo ◽  
Seungpyo Nam ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
High Volume ◽  
Case Volume ◽  
Hospital Case ◽  
Hip Fracture Surgery ◽  
Low Volume ◽  
One Year ◽  
Fracture Surgery ◽  
Very High

Aims Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Methods Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. Results Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). Conclusion Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384–1391.

scholarly journals Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality

2021 ◽  
Vol 2 (9) ◽  
pp. 710-720
Author(s):  
Cato Kjaervik ◽  
Jan-Erik Gjertsen ◽  
Lars B. Engeseter ◽  
Eva Stensland ◽  
Eva Dybvik ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Waiting Time ◽  
Waiting Times ◽  
Working Hours ◽  
High Volume ◽  
Mortality Rates ◽  
Hip Fracture Surgery ◽  
Low Volume ◽  
One Year ◽  
Fracture Surgery

Aims This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time. Methods Overall, 37,708 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked with data in the Norwegian Patient Registry. Hospitals treating hip fractures were characterized according to their hip fracture care. Waiting time (hours from admission to start of surgery), surgery within regular working hours, and surgery on the day of or on the day after admission, i.e. ‘expedited surgery’ were estimated. Results Mean waiting time was 22.6 hours (SD 20.7); 36,652 patients (97.2%) waited less than three days (< 72 hours), and 27,527 of the patients (73%) were operated within regular working hours (08:00 to 16:00). Expedited surgery was given to 31,675 of patients (84%), and of these, 19,985 (53%) were treated during regular working hours. Patients classified as American Society of Anesthesiologists (ASA) classes 4 and 5 were more likely to have surgery within regular working hours (odds ratio (OR) 1.59; p < 0.001), and less likely to receive expedited surgery than ASA 1 patients (OR 0.29; p < 0.001). Low-volume hospitals treated a larger proportion of patients during regular working hours than high volume hospitals (OR 1.26; p < 0.001). High-volume hospitals had less expedited surgery and significantly longer waiting times than low and intermediate-low volume hospitals. Higher ASA classes and Charlson Comorbidity Index increased waiting time. Patients not receiving expedited surgery had higher 30-day and one-year mortality rates (OR 1.19; p < 0.001) and OR 1.13; p < 0.001), respectively. Conclusion There is inequality in waiting time for hip fracture treatment in Norway. Variations in waiting time from admission to hip fracture surgery depended on both patient and hospital factors. Not receiving expedited surgery was associated with increased 30-day and one-year mortality rates. Cite this article: Bone Jt Open 2021;2(9):710–720.

scholarly journals One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan

2017 ◽  
Vol 8 (4) ◽  
pp. 402 ◽  
Author(s):  
Tien-Ching Lee ◽  
Pei-Shan Ho ◽  
Hui-Tzu Lin ◽  
Mei-Ling Ho ◽  
Hsuan-Ti Huang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Population Based ◽  
Population Based Study ◽  
National Population ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery ◽  
Readmission Risk

scholarly journals One-year results of the pilot multicentre randomised trial of preoperative focused cardiac ultrasound in hip fracture surgery

2019 ◽  
Vol 47 (2) ◽  
pp. 207-208 ◽  
Author(s):  
David J Canty ◽  
Johan Heiberg ◽  
Yang Yang ◽  
Alistair G Royse ◽  
Swaroop Margale ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Randomised Trial ◽  
Cardiac Ultrasound ◽  
Focused Cardiac Ultrasound ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery

scholarly journals DELIRIUM MOTOR SUBTYPES AND ONE-YEAR MORTALITY AFTER HIP FRACTURE SURGERY

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1317-1318
Author(s):  
L. Carnevali ◽  
P. Mazzola ◽  
M. Corsi ◽  
G. Bellelli ◽  
G. Annoni
Keyword(s):  
Hip Fracture ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery

Prediction Model of In-Hospital Mortality After Hip Fracture Surgery

2018 ◽  
Vol 32 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Atsushi Endo ◽  
Heather J. Baer ◽  
Masashi Nagao ◽  
Michael J. Weaver
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
Prediction Model ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors

Medicine ◽  
2017 ◽  
Vol 96 (16) ◽  
pp. e6683 ◽  
Author(s):  
Boris Sobolev ◽  
Pierre Guy ◽  
Katie J. Sheehan ◽  
Eric Bohm ◽  
Lauren Beaupre ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Care Delivery ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Evaluation of the volume-value relationship in hip fracture care using evidence-based thresholds

2019 ◽  
Vol 30 (3) ◽  
pp. 347-353
Author(s):  
Sergio M Navarro ◽  
William C Frankel ◽  
Heather S Haeberle ◽  
Damien G Billow ◽  
Prem N Ramkumar
Keyword(s):  
Hip Fracture ◽  
Operating Characteristic ◽  
Care Delivery ◽  
High Volume ◽  
Fracture Repair ◽  
Fracture Care ◽  
Hip Fracture Surgery ◽  
Lower Volume ◽  
Relative Market Share ◽  
Fracture Surgery

Background: Studies have shown high-volume surgeons and hospitals deliver higher value care. The aims of this study were to establish meaningful thresholds defining high-volume surgeons and hospitals performing hip fracture surgery and to examine the relative market share of hip fracture cases using these surgeon and hospital strata. Methods: We performed a retrospective cohort study in a database of 103,935 patients undergoing hip fracture repair. We generated stratum-specific likelihood ratio (SSLR) models of a receiver operating characteristic (ROC) curve using length of stay (LOS) and cost value metrics. Volume thresholds predictive of decreased LOS and costs for surgeons and hospitals were identified. Results: Analysis of annual surgeon hip fracture volume produced two volume categories for LOS and cost: 0–30 (low) and 31+ (high). Analysis of LOS by annual hospital hip fracture volume produced strata at: 0–59 (low), 60–146 (medium), and 147 or more (high). Analysis of cost by annual hospital volume produced strata at: 0–125 (low) and 126+ (high). LOS and cost both decreased significantly ( p < 0.05) in progressively higher volume categories. Low-volume surgeons performed the majority of hip fracture cases, although they were performed at medium- or high-volume centres. Conclusions: This study demonstrates a direct relationship between volume and value, translating to improvement in hip fracture care delivery for both surgeons and hospitals. Higher volume hospitals while lower volume surgeons perform the majority of hip fracture cases, suggesting optimisation opportunities. However, systems-based practices at the hospital level likely drive value to a greater extent than individual surgeons.

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