Faculty Opinions recommendation of Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes: A Population-based Cohort Study.

2017 ◽  
Author(s):  
Davide Cattano
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Population Based ◽  
Neuraxial Anesthesia ◽  
Hospital Level ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes

2018 ◽  
Vol 128 (3) ◽  
pp. 480-491 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Duminda N. Wijeysundera ◽  
Allen Huang ◽  
Gregory L. Bryson ◽  
Carl van Walraven
Keyword(s):  
Hip Fracture ◽  
Population Based ◽  
Neuraxial Anesthesia ◽  
Sensitivity Analyses ◽  
Causal Mechanism ◽  
Hospital Level ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
A Prospective Study ◽  
Fracture Surgery

Abstract Background There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). Methods We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed. Conclusions Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients.

scholarly journals Hospital-, Anesthesiologist-, and Patient-level Variation in Primary Anesthesia Type for Hip Fracture Surgery

2018 ◽  
Vol 129 (6) ◽  
pp. 1121-1131 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Duminda N. Wijeysundera ◽  
Gregory L. Bryson ◽  
Allen Huang ◽  
Colin J. L. McCartney ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Odds Ratio ◽  
Antiplatelet Agents ◽  
Neuraxial Anesthesia ◽  
Hospital Level ◽  
Patient Factors ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Manuscript Tells Us That Is New Background Substantial variation in primary anesthesia type for hip fracture surgery exists. Previous work has demonstrated that patients cared for at hospitals using less than 20 to 25% neuraxial anesthesia have decreased survival. Therefore, the authors aimed to identify sources of variation in anesthesia type, considering patient-, anesthesiologist-, and hospital-level variables. Methods Following protocol registration (NCT02787031), the authors conducted a cross-sectional analysis of a population-based cohort using linked administrative data in Ontario, Canada. The authors identified all people greater than 65 yr of age who had emergency hip fracture surgery from April 2002 to March 2014. Generalized linear mixed models were used to account for hierarchal data and measure the adjusted association of hospital-, anesthesiologist-, and patient-level factors with neuraxial anesthesia use. The proportion of variation attributable to each level was estimated using variance partition coefficients and the median odds ratio for receipt of neuraxial anesthesia. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic. The median odds ratio for receiving neuraxial anesthesia was 2.36 between randomly selected hospitals and 2.36 between randomly selected anesthesiologists. The majority (60.1%) of variation in neuraxial anesthesia use was explained by patient factors; 19.9% was attributable to the anesthesiologist providing care and 20.0% to the hospital where surgery occurred. The strongest patient-level predictors were absence of preoperative anticoagulant or antiplatelet agents, absence of obesity, and presence of pulmonary disease. Conclusions While patient factors explain most of the variation in neuraxial anesthesia use for hip fracture surgery, 40% of variation is attributable to anesthesiologist and hospital-level practice. Efforts to change practice patterns will need to consider hospital-level processes and anesthesiologists’ intentions and behaviors.

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery.MethodsA nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010.ResultsThe study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010.ConclusionsThe findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.

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 Variation in timely surgery for hip fracture by day and time of presentation: a nationwide prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland

2020 ◽  
pp. bmjqs-2020-011196
Author(s):  
Anjali Shah ◽  
Gulraj S Matharu ◽  
Dominic Inman ◽  
Elizabeth Fagan ◽  
Antony Johansen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Northern Ireland ◽  
Population Based ◽  
Quality Healthcare ◽  
Adjusted Risk ◽  
Hip Fracture Surgery ◽  
Average Patient ◽  
American Society ◽  
American Society Of Anesthesiologists

Background and ObjectiveSeveral studies report poorer quality healthcare for patients presenting at weekends. Our objective was to examine how timely surgery for patients with hip fracture varies with day and time of their presentation.MethodsThis population-based cohort study used 2017 data from the National Hip Fracture Database, which recorded all patients aged 60 years and over who presented with a hip fracture at a hospital in England, Wales and Northern Ireland. Provision of prompt surgery (surgery within 36 hours of presentation) was examined, using multivariable logistic regression with generalised estimating equations to derive adjusted risk ratios (RRs). Time was categorised into three 8-hour intervals (day: 08:00–15:59, evening: 16:00–23:59 and night: 00:00–07:59) for each day of the week. The model accounted for clustering by hospital and was adjusted by sex, age, fracture type, operation type, American Society of Anesthesiologists grade, preinjury mobility and location.ResultsWe studied 68 977 patients from 177 hospitals. The average patient presenting during the day on Friday or Saturday was significantly less likely to undergo prompt surgery (Friday during 08:00–15:59, RR=0.93, 95% CI 0.91 to 0.96; Saturday during 08:00–15:59, RR=0.91, 95% CI 0.88 to 0.94) than patients in the comparative category (Thursday, during the day). Patients presenting during the evening (16:00–23:59) were consistently significantly less likely to undergo prompt surgery, and the effect was more marked on Fridays and Saturdays (Friday during 16:00-23:59, RR=0.83, 95% CI 0.80 to 0.85; Saturday during 16:00–23:59, RR=0.81, 95% CI 0.78 to 0.85). Patients presenting overnight (00:00–07:59), except on Saturdays, were significantly more likely to undergo surgery within 36 hours (RR>1.07).ConclusionThe provision of prompt hip fracture surgery was complex, with evidence of both an ‘evening’ and a ‘night’ effect. Investigation of weekly variation in hip fracture care is required to help implement strategies to reduce the variation in timely surgery throughout the entire week.

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