scholarly journals Factors influencing postoperative LOS after fragility hip fracture surgery: public perceptions – a mixed methods study

2019 ◽  
Author(s):  
Takawira Marufu ◽  
Dalal Almghairbi ◽  
Heather Elphick ◽  
Farah B Ahmed ◽  
Iain K Moppett
Keyword(s):  
Mixed Methods ◽  
Hip Fracture ◽  
Rating Scales ◽  
Social Issues ◽  
Length Of Hospital Stay ◽  
Recovery Process ◽  
Medical Conditions ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Factors Influencing

Abstract Background Postoperative patient outcomes after hip fracture are significant to patients and their relatives, clinicians and policy makers. However, little is known about the collective views of these stakeholders on postoperative factors perceived to cause prolonged hospitalisation in this patient population. We aimed to explore individual stakeholders’ opinions on factors influencing timing of discharge.Methods Using a mixed methods approach, healthcare professionals, patients and relatives completed a questionnaire and interviews. The questionnaire consisted of 13 morbidity and non-medical domains on a five-point Likert scale. Participants were asked to rank each item identifying its importance in influencing length of hospital stay; 1 = strongly disagree, 2 = disagree, 3 = neither disagree nor agree, 4 = agree, 5 = strongly agree. Interviews were semi-structured exploring participant perceptions.Findings Twenty-six participants completed both interviews and questionnaires; three completed questionnaires only. Five themes affecting LOS emerged from interview data analysis; medical conditions, age and frailty, psychological aspects, the recovery process and social issues. There were some differences between the importance attributed by the semi-quantitative rating scales and the qualitative themes generated. Quantitative data suggested medical factors (pulmonary, infectious, gastrointestinal, cardiovascular, neurological, haematological, wound and pain). The interviews however highlighted functional and social aspects of recovery as key for patients and relative participants.Conclusion Recovery and discharge from hospital following hip fracture is understood by patients, carers or staff to be a complex interplay between medical conditions, psychosocial factors and the practicalities of living with increased dependency. Approaches to improving outcome will need to address each of these domains if they are to be effective.

Haemoglobin predicts length of hospital stay after hip fracture surgery in older patients

Maturitas ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Jorien M. Willems ◽  
Anton J.M. de Craen ◽  
Rob G.H.H. Nelissen ◽  
Peter A. van Luijt ◽  
Rudi G.J. Westendorp ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Stay ◽  
Older Patients ◽  
Length Of Hospital Stay ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Impact of Preoperative Specialty Consults on Hospitalist Comanagement of Hip Fracture Patients

2019 ◽  
Vol 15 (01) ◽  
pp. 16-21 ◽  
Author(s):  
Nicholas Bellas ◽  
Sherry Stohler ◽  
Courtland Lewis ◽  
Stephen Davis ◽  
Mandeep Kumar
Keyword(s):  
Hip Fracture ◽  
Negative Impact ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Active Management ◽  
Care Hospital ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment ◽  
Fragility Hip Fracture ◽  
Study Setting

BACKGROUND: Hip fractures typically occur in frail elderly patients. Preoperative specialty consults, in addition to hospitalist comanagement, are often requested for preoperative risk assessment. OBJECTIVE: Determine if preoperative specialty consults meaningfully influence management and outcomes in hip fracture patients, while being comanaged by hospitalists DESIGN: Retrospective cohort study SETTING: Tertiary care hospital in Connecticut PATIENTS: 491 patients aged 50 years and older who underwent surgery for an isolated fragility hip fracture, defined as one occurring from a fall of a height of standing or less. INTERVENTION: Presence or absence of a preoperative specialty consult MEASUREMENTS: Time to surgery (TTS), length of hospital stay (LOS), and postoperative complications RESULTS: 177 patients had a preoperative specialty consult. Patients with consults were older and had more comorbidities. Most consult recommendations were minor (72.8%); there was a major recommendation only for eight patients (4.5%). Multivariate analysis demonstrates that consults are more likely to be associated with a TTS beyond 24 hours (Odds Ratio [OR] 4.28 [2.79-6.56]) and 48 hours (OR 2.59 [1.52-4.43]), an extended LOS (OR 2.67 [1.78-4.03]), and a higher 30-day readmission rate (OR 2.11 [1.09-4.08]). A similar 30-day mortality rate was noted in both consult and no-consult groups. CONCLUSIONS: The majority of preoperative specialty consults did not meaningfully influence management and may have potentially increased morbidity by delaying surgery. Our data suggest that unless a hip fracture patient is unstable and likely to require active management by a consultant, such consults offer limited benefit when weighed against the negative impact of surgical delay.

scholarly journals A feasibility study to assess the design of a multicentre randomized controlled trial of the clinical and cost-effectiveness of a caregiving intervention for people following hip fracture surgery

2021 ◽  
Vol 2 (11) ◽  
pp. 909-920
Author(s):  
Toby Smith ◽  
Lucy Clark ◽  
Reema Khoury ◽  
Mei-See Man ◽  
Sarah Hanson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Mixed Methods ◽  
Cost Effectiveness ◽  
Hip Fracture ◽  
Goal Setting ◽  
Controlled Trial ◽  
Training Programme ◽  
Hip Fracture Surgery ◽  
Randomized Controlled ◽  
Fracture Surgery

Aims This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. Methods This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals. Discussion A multicentre recruitment approach will provide greater external validity across population characteristics in England. The mixed-methods approach will permit in-depth examination of the intervention and trial design parameters. The findings will inform whether and how a definitive trial may be undertaken to test the effectiveness of this caregiver intervention for patients after hip fracture surgery. Cite this article: Bone Jt Open 2021;2(11):909–920.

scholarly journals Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

2021 ◽  
Author(s):  
S Tan ◽  
A Vasireddy
Keyword(s):  
Hip Fracture ◽  
Functional Recovery ◽  
Early Mobilisation ◽  
Local Study ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Current Trends ◽  
Significant Difference ◽  
Fracture Surgery ◽  
Early Functional Recovery

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gaps

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. The aim of this project was to identify evidence to practice gaps in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery.Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included.Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment.Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gap

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. Objective To identify if there is an evidence to practice gap in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery. Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023609 ◽  
Author(s):  
Ana Kowark ◽  
Christian Adam ◽  
Jörg Ahrens ◽  
Malek Bajbouj ◽  
Cornelius Bollheimer ◽  
...  
Keyword(s):  
Hip Fracture ◽  
General Anaesthesia ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Open Label ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Randomised Controlled ◽  
Fracture Surgery

IntroductionHip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse.Methods and analysisThe iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design. In total, 1032 patients with hip fracture (>65 years) will be randomised in an intended 1:1 allocation ratio to receive spinal anaesthesia (n=516) or general anaesthesia (n=516). Outcome assessment will occur in a blinded manner after hospital discharge and inhospital. The primary endpoint will be assessed by telephone interview and comprises the time to the first occurring event of the binary composite outcome of all-cause mortality or new-onset serious cardiac and pulmonary complications within 30 postoperative days. In-hospital secondary endpoints, assessed via in-person interviews and medical record review, include mortality, perioperative adverse events, delirium, satisfaction, walking independently, length of hospital stay and discharge destination. Telephone interviews will be performed for long-term endpoints (all-cause mortality, independence in walking, chronic pain, ability to return home cognitive function and overall health and disability) at postoperative day 30±3, 180±45 and 365±60.Ethics and disseminationiHOPE has been approved by the leading Ethics Committee of the Medical Faculty of the RWTH Aachen University on 14 March 2018 (EK 022/18). Approval from all other involved local Ethical Committees was subsequently requested and obtained. Study started in April 2018 with a total recruitment period of 24 months. iHOPE will be disseminated via presentations at national and international scientific meetings or conferences and publication in peer-reviewed international scientific journals.Trial registration numberDRKS00013644; Pre-results

scholarly journals 51 A Prospective Study on Falls Efficacy and Functional Outcomes after HIP Fracture Surgery in a Singapore Orthogeriatric Programme

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Kiat Sern Goh ◽  
Kiat Mun Serena ◽  
Thulasi Chandran
Keyword(s):  
Hip Fracture ◽  
Self Efficacy ◽  
Functional Outcomes ◽  
Community Hospital ◽  
Weight Bearing ◽  
Depression Scale ◽  
Community Dwelling ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Introduction Fear of Falling (FoF) is common after hip fracture and associated with adverse outcomes including impaired functional recovery and recurrent falls. The objective of this study was to measure self-efficacy related to falls and its association with functional outcomes after hip fracture surgery. Methods A prospective cohort study was performed on 106 community-dwelling elderly aged ≥65 years without dementia, admitted to a community hospital for rehabilitation after surgery for fragility hip fracture in Singapore. They were managed in an integrated multidisciplinary orthogeriatric programme, transitioning from acute orthopaedic unit to the affiliated community hospital. Falls Efficacy Scale (FES; range 10-100) was assessed on discharge. Main outcomes measured included Parker Mobility Score (PMS) and Modified Barthel Index (MBI) at 3 months. Results Key characteristics of the cohort were: mean age 79.4(SD 6.38); female 74%, Chinese 83%, pre-fracture PMS 6.7(SD 2.7); pre-fracture MBI 81.1(SD 20.9); mean FES score 32.0(SD 23.7). At 3 months, mean PMS was 3.97(SD 2.51); mean MBI was 73(SD 20.1), demonstrating that the cohort overall did not regain their pre-morbid functional levels. FES was negatively correlated with both 3-month MBI and PMS with coefficients -0.592 and -0.523 respectively (p<0.001). FES was negatively associated with 3-month MBI and PMS in the multiple linear regression model, having adjusted for demographics, comorbidities, pre-fracture MBI and PMS, MMSE, geriatric depression scale, and post-operative weight-bearing status, with corresponding βs -0.26(95%CI -0.49 to -0.02;p=0.032) and -0.03(95%CI -0.06 to -0.00;p=0.044). Conclusion FoF is a potentially modifiable factor linked to adverse functional outcomes in hip fracture rehabilitation, indicating the necessity to address falls self-efficacy as a major component of assessment and intervention, whilst further exploring the local validity and applicability of various instruments measuring FoF. Further studies need to be conducted on the evolving patterns of FoF over time and its impact on longer-term functional and psychosocial outcomes.

When does hip fracture surgery delay affects the length of hospital stay?

2021 ◽  
Author(s):  
Anže Kristan ◽  
Sabastjan Omahen ◽  
Theodoros Hercules Tosounidis ◽  
Matej Cimerman
Keyword(s):  
Hip Fracture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hip Fracture Surgery ◽  
Surgery Delay ◽  
Fracture Surgery
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