Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

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Does a Dedicated Unit for the Treatment of Hip Fractures Improve Acute Outcomes?

International Scholarly Research Notices ◽

10.1155/2014/385701 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Al-achraf Khoriati ◽

Wael Dandachli ◽

Rupinderbir Deol ◽

Nicholas de Roeck

Keyword(s):

Nursing Home ◽

Mortality Rate ◽

Length Of Stay ◽

Hip Fractures ◽

Time To Surgery ◽

Trauma Unit ◽

Group 2 ◽

Inpatient Length Of Stay ◽

Group 1

The aim of this study is to establish whether management of patients in a unit dedicated to the treatment of hip fractures improves acute outcomes. We prospectively studied 300 patients with hip fractures in two separate groups. Patients in Group 1 were operated on in a mixed trauma unit and recovered in a traditional trauma ward. Patients in Group 2 were operated on in dedicated theatres and recovered in a unit which catered exclusively for hip fractures. The ages, ASA grades, and type of procedure performed in the two groups were comparable. The 30-day mortality rate in Group 2 was 9% as opposed to 12% in Group 1 (P=0.34). The inpatient length of stay was significantly lower in Group 2 (18 days versus 25 days; P=0.0002) and so was the time taken to operate (28 hours versus 34 hours; P=0.04). A greater percentage of patients in Group 2 were discharged home as opposed to a nursing home (75% versus 67%). This difference approached significance (P=0.18). We conclude that prioritisation and prompt management of patients with hip fractures in a dedicated unit significantly improve time to surgery and significantly decrease length of stay.

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Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol

Hip International ◽

10.1177/1120700020919332 ◽

2020 ◽

pp. 112070002091933

Author(s):

Anthony V Christiano ◽

Hannah C Elsevier ◽

Salman Sarker ◽

George Agriantonis ◽

David Joseph ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

Safety Net ◽

Management Service ◽

Protocol Implementation ◽

Time To Surgery ◽

Number Of Patients ◽

Safety Net Hospital ◽

Urban Safety

Introduction: standardised protocols for the care of geriatric hip fractures demonstrate improved patient outcomes with decreased cost. The purpose of this study is to evaluate outcomes of a standardised hip fracture protocol at an urban safety-net hospital. Methods: All trauma patients presenting to our urban safety-net hospital are included in a trauma database and inpatient outcomes recorded. A hip fracture protocol was introduced at our institution in 2015, which depended on admission to a monitored setting due to the absence of a geriatric co-management service. The database was queried to identify patients surgically treated for a geriatric hip fracture in the 3 years prior to protocol implementation (2012–2014) and patients treated in the 3 years following protocol implementation (2016–2018). Demographics, time to surgery, inpatient complications, and length of stay were compared between groups. Results: A total of 633 patients treated operatively for isolated hip fractures were identified, 262 patients in the 2012–2014 pre-protocol cohort, and 371 patients in the 2016–2018 protocol cohort. Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p < 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days ( p = 0.054). The complication rate fell from 23% to 4% ( p < 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days ( p = 0.045). Conclusions: A hip fracture protocol including admission to a monitored setting can be effectively implemented at an urban safety-net hospital where geriatric co-management is not available. This resulted in a decrease in complications and length of stay. Additional interventions are required to decrease average time to surgery below 36 hours.

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Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings

BMC Geriatrics ◽

10.1186/s12877-021-02509-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Unchana Sura-amonrattana ◽

Theerawoot Tharmviboonsri ◽

Aasis Unnanuntana ◽

Direk Tantigate ◽

Varalak Srinonprasert

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hip Fractures ◽

Multidisciplinary Team ◽

Fast Track ◽

Medical Complications ◽

Resource Limited Settings ◽

Time To Surgery ◽

Resource Limited ◽

Significant Difference

Abstract Background Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. Methods A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. Results Three hundred two patients were enrolled from the Siriraj hospital’s database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p < 0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-h (80.3% VS 44.7%, p < 0.001) and the length of stay was significantly shorter (11 days (8–17) VS 13 days (9–18), p = 0.017). There was no significant difference in medical complications. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality. Conclusions The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.

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Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

ISRN Hematology ◽

10.5402/2011/294628 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 17

Author(s):

Feras Ashouri ◽

Wissam Al-Jundi ◽

Akash Patel ◽

Jitendra Mangwani

Keyword(s):

Vitamin K ◽

Hip Fractures ◽

National Policy ◽

District General Hospital ◽

Pharmacological Therapy ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Time To Surgery ◽

Group A ◽

Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

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The independent patient factors that affect length of stay following hip fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0068 ◽

2018 ◽

Vol 100 (7) ◽

pp. 556-562 ◽

Cited By ~ 4

Author(s):

T Richards ◽

A Glendenning ◽

D Benson ◽

S Alexander ◽

S Thati

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hospital Stay ◽

Hip Fractures ◽

Length Of Hospital Stay ◽

Hospital Length ◽

Acute Hospital ◽

Hospital Length Of Stay ◽

Patient Factors ◽

Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

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Commentary: Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay

Neurosurgery ◽

10.1093/neuros/nyy494 ◽

2018 ◽

Vol 85 (6) ◽

pp. E1002-E1003

Author(s):

Eeric Truumees

Keyword(s):

United States ◽

Length Of Stay ◽

Trauma Care ◽

Trauma System ◽

The United States ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Spine Trauma ◽

Time To Surgery

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Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care

BMJ Open ◽

10.1136/bmjopen-2016-015574 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015574 ◽

Cited By ~ 12

Author(s):

Kristin Haugan ◽

Lars G Johnsen ◽

Trude Basso ◽

Olav A Foss

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Fast Track ◽

Conventional Care ◽

University Hospital ◽

Secondary Outcome ◽

Charlson Comorbidity Index Score ◽

Care Group ◽

Time To Surgery ◽

Significant Difference

ObjectiveTo compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.DesignRetrospective single-centre study.SettingUniversity hospital in middle Norway.Participants1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).Interventions788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013.Primary and secondary outcomePrimary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay.ResultsWe found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways.ConclusionsThere was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased.Trial registration numberNCT00667914; results

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Influence of Time to Surgery in Ankle Fractures on the Rate of Complications and Length of Stay – a Multivariate Analysis

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0658-1753 ◽

2018 ◽

Vol 157 (02) ◽

pp. 183-187

Author(s):

Rene Burchard ◽

Karacan Hamidy ◽

Anke Pahlkötter ◽

Christian Soost ◽

Michael Palm ◽

...

Keyword(s):

Multivariate Analysis ◽

Length Of Stay ◽

Ankle Fractures ◽

Time To Surgery

Zusammenfassung Hintergrund Mit einer Inzidenz von 9/1000 pro Jahr ist die Malleolarfraktur des oberen Sprunggelenkes eine der häufigsten Frakturen des menschlichen Skeletts. Häufig stellt sich die Frage, ob der Zeitpunkt einer operativen Maßnahme Einfluss auf die Komplikationsrate oder die Krankenhausverweildauer ausübt oder ob andere Patientencharakteristika oder Komorbiditäten darauf Einfluss nehmen. Material und Methoden Aufgrund der bisher sehr heterogenen Datenlage im Hinblick auf den optimalen Operationszeitpunkt bei Malleolarfrakturen erfolgte in der vorliegenden Arbeit eine multivariate Regressionsanalyse im Rahmen einer retrospektiven Kohortenstudie (n = 421). Ergebnisse In der multivariaten Regressionsanalyse zeigten sich keine Vorteile einer primären operativen Versorgung innerhalb von 6 Stunden gegenüber der sekundären Therapie nach ca. 1 Woche im Hinblick auf die lokale postoperative Komplikationsrate oder die Krankenhausverweildauer. Ein höheres Patientenalter bzw. ein begleitender Weichteilschaden höheren Grades waren mit einer verlängerten Krankenhausverweildauer assoziiert. Schlussfolgerung Diese aktuelle Auswertung eines 5-Jahres-Zeitraums zeigt, dass die Wahrscheinlichkeit des Auftretens einer schwerwiegenden lokalen Komplikation nach operativer Versorgung einer Malleolarfraktur weder vom OP-Zeitpunkt noch von weiteren Kovariablen wie dem Alter oder von Komorbiditäten des Patienten beeinflusst wird. Die Empfehlung der primären Versorgung innerhalb von 6 – 8 Stunden entsprechend der aktuellen S2-Leitlinie „Sprunggelenkfraktur“ sollte nach den Ergebnissen der vorliegenden Studie in einer prospektiv randomisierten Untersuchung reevaluiert werden.

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114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Neurosurgery ◽

10.1093/neuros/nyx417.114 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 224-224

Author(s):

Anthony Michael DiGiorgio ◽

Praveen V Mummaneni ◽

Jonathan Lloyd Fisher ◽

Adam Podet ◽

Clifford Crutcher ◽

...

Keyword(s):

Length Of Stay ◽

Tertiary Care ◽

Wait Time ◽

Multivariate Regression Analysis ◽

Safety Net ◽

Neurosurgical Procedures ◽

Urgent Surgery ◽

Period 2 ◽

Safety Net Hospital ◽

The Impact

Abstract INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.

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