Can Payment by Results Improve Hip Fracture Surgery Delays?

2010 ◽  
Vol 92 (7) ◽  
pp. 1-3
Author(s):  
T Nunn ◽  
W Salloum ◽  
D Pinch ◽  
S Naima
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Waiting Time ◽  
Independent Risk Factor ◽  
Patient Choice ◽  
Poor Health ◽  
Delayed Surgery ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
British Orthopaedic Association

Mortality following hip fracture surgery is high, with 7% mortality at 30 days and 18% at 120 days. This reflects the pre-existing poor health of some of those who present with such an injury. Large studies have demonstrated that delayed surgery is an independent risk factor for mortality. The British Orthopaedic Association (BOA) recommends that hip fracture surgery be undertaken within 48 hours in all those medically fit. Payment by Results (PbR) was introduced in July 2000 in the NHS Plan, linking the allocation of funds to hospitals to the activity undertaken. This was designed to 'provide a transparent, rules-based system […] which would reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions'.

scholarly journals End-Stage Renal Failure Is an Independent Risk Factor for 1-Year Mortality After Hip Fracture Surgery

2018 ◽  
Vol 9 ◽  
pp. 215145931877056 ◽  
Author(s):  
Louise Woon Theng Lo ◽  
Xu Yanling ◽  
Andrew Chia Chen Chou ◽  
Tet Sen Howe ◽  
John Carson Allen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Risk Factor ◽  
Hip Fracture ◽  
Independent Risk Factor ◽  
Postoperative Mortality ◽  
End Stage Renal Failure ◽  
Hip Fracture Surgery ◽  
End Stage ◽  
Fracture Surgery

Introduction: End-stage renal failure (ESRF) with its associated comorbidities increase postoperative mortality in hip fracture patients. This study investigated the association of ESRF with various comorbidities in patients on dialysis and assessed rates ESRF as an independent risk factor for all-cause postoperative 1- year mortality rates. Methods: This was a retrospective cohort study on patients aged 55 years and older who underwent their first nonpathological, low-energy hip fracture surgery at an Asian tertiary hospital from June 2007 to 2012. Patients were identified as cases with ESRF on dialysis (study group) or non-ESRF patients (controls). Various comorbidity factors and postoperative 1-year mortality status were obtained from institutional electronic medical records. Univariate and multivariate logistic regression were used to identify significant risk factors for all-cause, 1-year mortality. Results: With no loss to follow-up, the 1-year postoperative mortality rate was 19.6% for the 46 patients with ESRF on dialysis and 8.4% for non-ESRF controls ( P = .028). Fisher exact test showed that hypertension, ischemic heart disease (IHD), diabetes mellitus (DM), anemia, cerebrovascular disease, and vascular disease were significantly associated with ESRF ( P < .05). Multivariable logistic regression analysis identified ESRF (adjusted odds ratio[AOR] = 2.85, P = .021), cancer (AOR = 3.04, P = .003), IHD (AOR = 2.07, P = .020), DM (AOR = 2.03, P = .022), and age (AOR = 1.08, P <.0001) as independent risk factors for 1-year mortality following hip fracture surgery. The area under the receiver–operating characteristic curve (95% confidence interval) for the multivariable predictor of 1-year mortality was 0.75 (0.60-0.82). Conclusions: Although associated with multiple comorbidities, ESRF was found to be independently predictive of 1-year mortality in patients undergoing hip fracture surgery, second to cancer in terms of magnitude of risk posed. As ESRF is a negative prognostic factor for 1-year mortality after hip fracture surgery, its importance should be recognized with implications on preoperative counseling to patients about the increased risk and implications on fracture prevention.

scholarly journals Malondialdehyde on postoperative day 1 predicts postoperative cognitive dysfunction in elderly patients after hip fracture surgery

2019 ◽  
Vol 39 (6) ◽  
Author(s):  
Chunxian Wu ◽  
Bin Gao ◽  
Yu Gui
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Independent Risk Factor ◽  
Postoperative Cognitive Dysfunction ◽  
Curve Analysis ◽  
Elderly Subjects ◽  
Multivariate Logistic Regression ◽  
Roc Curve Analysis ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Background: Postoperative cognitive dysfunction (POCD) is a great problem for anesthetized subjects and is associated with poor short- and long-term outcomes. We explored promising predictors for POCD in elderly patients after hip fracture surgery. Methods: Elderly subjects (aged ≥65 years) undergoing surgery for hip fracture were consecutively recruited. Neuropsychological assessments were performed 1 day preoperatively (baseline) and 7 days postoperatively, and POCD was defined using the ‘Z scores’ method. Clinical data and laboratory tests were compared between patients with and without POCD development. Binary univariate and multivariate logistic regression analyses were conducted for risk factor assessment. Receiver operating characteristic (ROC) curve analysis was performed to investigate the predictive value of malondialdehyde (MDA) on postoperative day 1 (POD1) for POCD. Results: A total of 198 patients were finally enrolled in the analysis and 51 patients exhibited POCD within 7 postoperative days, with an incidence rate of 25.8%. MDA expression on POD1 (OR: 1.12, 95%CI: 1.03–1.23, P=0.017) was the only independent risk factor for POCD according to the final multivariate logistic regression analysis. ROC curve analysis indicated that MDA on POD1 was a predictor for POCD, with an area under the curve (AUC) of 0.683 and 95%CI of 0.590–0.775 (P<0.001). Conclusions: In conclusion, we demonstrated that MDA on POD1 was an independent risk factor for POCD in elderly subjects undergoing hip fracture surgery.

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

Post-operative mortality related to waiting time for hip fracture surgery

Injury ◽  
2005 ◽  
Vol 36 (8) ◽  
pp. 984 ◽  
Author(s):  
R. Bansal ◽  
J. Luscombe ◽  
J.P. Cooper
Keyword(s):  
Hip Fracture ◽  
Waiting Time ◽  
Operative Mortality ◽  
Hip Fracture Surgery ◽  
Fracture Surgery
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