Abstract
For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type.MethodsPatients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient characteristics, fracture type, operation method, lead-times and outcome were analyzed. For comparison Fischer’s exact test and Spearman’s rank correlation coefficient was used for the categorical data and Pearson correlation coefficient for the continuous. To further analyze the effect over time a linear regression model was used.ResultsA total of 7827 patients were included. A significant shift in the overall morbidity was seen, with an increase in patients of higher ASA grade. No correlation was seen between outcome and the care process development. The mortality rate for the group as a whole the mortality rate had decreased over time. The total length of stay had decreased significantly over time. There was no statistically significant change in mortality rate over time when relating it to time-to-surgery.ConclusionsAlthough the patients display a higher morbidity over time, the mortality rate has not changed significantly, which might indicate an effect of the care process development.The care process development does not seem to impact on outcome as much as other factors.This study supports the possibility to create a more specific algorithm for hip fracture patients, taking specific subgroups into consideration.
Highlights
To suffer from a hip fracture is a serious condition associated with high mortality, risk of complications and a decrease in functional level [1,2,3,4,5]
Aim The aim of this study is to investigate the impact of care process development and morbidity on time to surgery, mortality rate and functional outcome for hip fracture patients over a 19 year long period
Functional outcome, Total length of hospital stay (LOS) and care process development Our study shows statistic dependency between housing and walking ability both pre-fracture and at follow-up (p < 0.001), where independent walking ability correlates to living in own home
Summary
To suffer from a hip fracture is a serious condition associated with high mortality, risk of complications and a decrease in functional level [1,2,3,4,5]. Further improvements were made in October 2003 by introducing a new clinical pathway With this clinical pathway the care of the patient started in the ambulance with distribution of pain relief, iv fluids and oxygen, and after x-ray the patient was taken directly to the orthopedic ward, as apposed to going back to the ED and wait for admittance. This led to a reduction of lead-times from X-ray to surgery [8]. The changes made led to a reduction in pressure ulcers and delirium, as well as a time gain from admission to x-ray and a reduced hospital stay
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