Abstract
The Blue Book published by the British Orthopaedic Association and British Geriatrics Society, together with the introduction of National Hip Fracture Database Audit and Best Practice Tariff, have been influential in improving hip fracture care. We examined ten-year (2009–2019) changes in hip fracture outcomes after establishing an orthogeriatric service based on these initiatives, in 1081 men and 2891 women (mean age = 83.5 ± 9.1 years). Temporal trends in the annual percentage change (APC) of outcomes were identified using the Joinpoint Regression Program v4.7.0.0. The proportions of patients operated beyond 36 h of admission fell sharply during the first two years: APC = − 53.7% (95% CI − 68.3, − 5.2, P = 0.003), followed by a small rise thereafter: APC = 5.8% (95% CI 0.5, 11.3, P = 0.036). Hip surgery increased progressively in patients > 90 years old: APC = 3.3 (95% CI 1.0, 5.8, P = 0.011) and those with American Society of Anaesthesiologists grade ≥ 3: APC = 12.4 (95% CI 8.8, 16.1, P < 0.001). There was a significant decline in pressure ulcers amongst patients < 90 years old: APC = − 17.9 (95% CI − 32.7, 0.0, P = 0.050) and also a significant decline in mortality amongst those > 90 years old: APC = − 7.1 (95% CI − 12.6, − 1.3, P = 0.024). Prolonged length of stay (> 23 days) declined from 2013: APC = − 24.6% (95% CI − 31.2, − 17.4, P < 0.001). New discharge to nursing care declined moderately over 2009–2016 (APC = − 10.6, 95% CI − 17.2, − 2.7, P = 0.017) and sharply thereafter (APC = − 47.5%, 95%CI − 71.7, − 2.7, P = 0.043). The rate of patients returning home was decreasing (APC = − 2.9, 95% CI − 5.1, − 0.7, P = 0.016), whilst new discharge to rehabilitation was increasing (APC = 8.4, 95% CI 4.0, 13.0; P = 0.002). In conclusion, the establishment of an orthogeriatric service was associated with a reduction of elapsed time to hip surgery, a progressive increase in surgery carried out on high-risk adults and a decline in adverse outcomes.
Highlights
Hip fracture is a common condition in older people, sharing the largest proportion of hospital admissions amongst all types of fractures [1]
This study showed that after establishing the orthogeriatric service, there was a rapid reduction in elapsed time to surgery
People undergoing hip operations were increasingly older, and proportionally more of those over 90 years had severe systemic disease (ASA grade ≥ 3), there was no evidence for this impacting on detrimental effects including mortality and pressure ulcers
Summary
Hip fracture is a common condition in older people, sharing the largest proportion of hospital admissions amongst all types of fractures [1]. Patients with a hip fracture have increased risk of many adverse outcomes in hospital including prolonged hospitalisation, malnutrition, pressure ulcers, mortality and requirement for higher levels of care [2,3,4,5,6]. The personal and social costs of hip fractures are enormous [7, 8]. Whilst surgery is the main treatment to fix hip fractures, post-operative patient-care plays a key role in functional recovery, minimising hospital-associated complications and timely discharge. Efforts have been made to improve hip fracture management over the past 15 years. These include publication in 2005 of the Blue Book jointly
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
