Hip Fracture Program Research Articles

Effects of a Geriatrician‐Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes

The hip fracture service (HFS) is an interdisciplinary, geriatrician-led program instituted to improve the care of frail elderly people who present to the hospital with acute hip fracture. The HFS pilot project used existing hospital personnel and facilities and initiated new practices, including set protocols, preprinted orders, and standardized assessments, to achieve and evaluate patient triage and care and hospital cost savings. Outcome measures for 91 patients with acute hip fracture consecutively admitted to the HFS were compared with those of 72 historical controls managed under standard care in the prior year. Analysis demonstrated better outcomes in terms of length of stay (6.1+/-2.4 days for standard care, 4.6+/-1.1 days for the HFS; P<.001) and time to surgery (<24 hours after admission in 22.2% of standard care patients vs 50.5% of HFS patients; P<.001). Furthermore, the HFS model showed a reduction in total costs, resulting in a gain in net income, from a deficit of $908+/-4,977 (95% confidence interval (CI)=-$2,078-261) per patient in the standard group to a gain of $1,047+/-2,718 (95% CI=$481-1,613) per patient in the HFS group (P<.002). The findings suggest that care with set protocols overseen by a trained lead physician may improve the quality and cost effectiveness of managing elderly patients with hip fracture. Although the results must be interpreted with caution because of the pre-post design, this pilot study provides a model of care for further hypothesis generation and more rigorous testing into the quality and financial benefits of a geriatrics-led care process.

A Comprehensive Hip Fracture Program Reduces Complication Rates and Mortality

To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). Retrospective chart review with historical control. Orthopedic ward (110 beds) at a university hospital (700 beds). Five hundred thirty-five consecutive patients aged 40 and older (94%>or=60) hospitalized for hip fracture between January 1, 2003, and March 31, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. In the intervention group, the rate of any in-hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4-0.9; P=.002). Rates of confusion (P=.02), pneumonia (P=.03), and urinary tract infection (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P=.2). The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.

956 PUBLICATION Radiotherapy in the adjuvant setting of cervical carcinoma: Treatment results and prognostic factors

Of the 70,000 patients presenting in the UK each year with hip fracture, most are frail, elderly with multiple co-morbidities and polypharmacy. Falls are often attributed to slips or trips, but many reflect the patient's inability to steady themself because of slowed reflexes, poor balance, underlying musculoskeletal disorders, poor vision and sarcopenia. A proportion of patients fall due to an inter-current medical illness, such as chest or urinary sepsis and others from acute presentation of stroke or cardiac arrhythmia.These patients require a coordinated multidisciplinary approach from the point of admission to the point of discharge. The National Institute for Health and Care Excellence (NICE) Guidance on hip fracture published in 2011 refers to the hip fracture programme [1]. This chapter aims to expand on the concept of the hip fracture programme and how this approach in the acute peri-operative period can ensure the best short-term outcomes as a foundation for the best possible longer-term outcomes.