Hip Fracture Management in an Orthogeriatric Clinical Care Center during the Covid-19 Pandemic in Bogotá, Colombia1

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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Hip Fracture Management

OTA International ◽

10.1097/oi9.0000000000000069 ◽

2020 ◽

Vol 3 (1) ◽

pp. e069

Author(s):

Theodore Miclau

Keyword(s):

Hip Fracture ◽

Fracture Management

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Hip Fracture Management for the Hospital-Based Clinician: A Review of the Evidence and Best Practices

Hospital Practice ◽

10.3810/hp.2011.02.374 ◽

2011 ◽

Vol 39 (1) ◽

pp. 52-61 ◽

Cited By ~ 13

Author(s):

Jason Hughson ◽

Jonathan Newman ◽

Robert C. Pendleton

Keyword(s):

Hip Fracture ◽

Best Practices ◽

Fracture Management

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528 EVALUATING THE PRESCRIPTION OF OPIATES IN PATIENTS WITH NECK OF FEMUR FRACTURES IN OUT OF HOSPITAL AND EMERGENCY CARE SETTING

Age and Ageing ◽

10.1093/ageing/afab116.16 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii8-ii13

Author(s):

S Kanabar ◽

D Mistry ◽

H Naeem ◽

R Smith ◽

F Zahir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hip Fracture ◽

Respiratory Depression ◽

Local Governance ◽

Statistical Tests ◽

Kidney Injury ◽

Adverse Outcomes ◽

Respiratory Compromise ◽

Femur Fractures ◽

Fracture Management

Abstract Introduction Opiate based analgesia forms a key component of Hip Fracture management. If prescribed inappropriately, opiate based analgesia can lead to respiratory depression, nephrotoxicity, and delayed recovery. The aim of this project was to evaluate opiate prescription in NOF patients in both out of hospital (OOH) and Emergency Department (ED). Methods 100 consecutive patients were identified from National Hip Fracture Database between January and August 2019. Medical records were reviewed in both care settings, reviewing dose of morphine in comparison to body weight and renal function. Outcomes measured include constipation, acute kidney injury, respiratory compromise, and mortality. Statistical tests (t-test and chi square) were used to discern significance. Following the first cycle of results, results were disseminated to paramedics and at local governance meetings. Teaching was undertaken to increase awareness of harms associated with inappropriate opiate prescribing. A second cycle evaluated 30 consecutive NOFs from July 2020. Results In our study population, 74% were female and the average age was 84. The range of morphine doses given OOH ranged from 2-40 mg, in comparison to 2.5-20 mg in ED. 18% of patient suffered from Respiratory depression with 48 hours of their admission with a further 7% suffering from an acute kidney injury. After intervention, OOH morphine doses ranged between 5-10 mg, a reduction of 75% on maximum dose, with increased use of adjuvants as guided by the WHO pain ladder. No adverse outcomes were noted within 48 hours of admission. Conclusion Patient safety should be high on the agenda whilst caring for frail patients with Hip Fractures and opiate prescription is one of the most critical in the patient’s journey. Reducing harm by prescribing the optimal opiates helps to reduce mortality, morbidity, improve rehabilitation and patient flow within the NHS pathways. A guideline has been published to aid opiate prescription in elderly patients.

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Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial

Gerontology and Geriatric Medicine ◽

10.1177/2333721417697663 ◽

2017 ◽

Vol 3 ◽

pp. 233372141769766 ◽

Cited By ~ 4

Author(s):

Sarah Stott-Eveneshen ◽

Joanie Sims-Gould ◽

Megan M. McAllister ◽

Lena Fleig ◽

Heather M. Hanson ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Hip Fracture ◽

Controlled Trial ◽

Qualitative Interviews ◽

Management Program ◽

Knowledge Resources ◽

Study Staff ◽

Fracture Management ◽

Positive Perspective

This study describes patients’ perspectives on recovery during participation in a randomized controlled trial that tested a postoperative hip fracture management program (B4 Clinic), compared with usual care, on mobility. Semistructured qualitative interviews were conducted with 50 older adults with hip fracture (from both groups) twice over 12 months. A total of 32 women (64%) and 18 men (36%) participated in the study with a mean age at baseline of 82 (range = 65-98) years. A total of 40 participants reported recovery goals at some point during their recovery from hip fracture but only 18 participants realized their goals within 12 months. Recovering mobility, returning to prefracture activities, and obtaining stable health were the most commonly reported goals. Participants described good social support, access to physiotherapy, and positive perspective as most important to recovery. These factors were influenced by participants’ knowledge, resources, and monthly contact with study staff (perceived as a form of social support). The most frequently reported barriers to participants’ recovery were the onset of complications, pain, and limited access to physiotherapy. Potential implications of these findings include design and modification of new or preexisting fracture programs, prioritizing patient engagement and enhanced knowledge for future clinical research in hip fracture recovery.

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Elderly Patients with Pertrochanteric Hip Fracture: In Hospital Care

Journal of Orthopedics & Bone Disorders ◽

10.23880/jobd-16000190 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-8

Author(s):

Faour Martín O

Keyword(s):

Health Care ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Cost Reduction ◽

Hospital Care ◽

Scientific Evidence ◽

Clinical Results ◽

Fracture Management ◽

Care Of Elderly

Objective: To evaluate the improvement in the care of elderly patients hospitalized due to pertrochanteric hip fractures. Methods: A comparative study of two cohorts of patients admitted due to pertrochanteric hip fractu re before (2010) and after the application of in hospital management protocols (2018). The intervention consisted in the implementation of multidisciplinary measures during hospitalization based on current scientific evidence. An evaluation of the clinical results was performed, as well as the health care impact. Results: The characteristics of patients admitted for hip fracture in 2010 (216 patients) and 2018 (205 patients) were similar in age, sex, Barthel index and the Charlson abbreviated index. In 2018 patients had more comorbidity. A significant reduction of preoperative stay and overall stay in the cohort of 2018 was achieved. Detection of delirium, malnutrition and anaemia was higher in 2018, and a reduced incidence of infection and a better function al efficiency was achieved in this period. Conclusion: The introduction of measures for the improvement of the pertrochanteric hip fracture management reduces hospitalization with consequent cost reduction. Unification of criteria among professionals may b e an opportunity for better clinical results and reduction of complications.

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