PROXIMAL FEMORAL FRACTURES: EFFECT OF THE SURGEON’S GRADE AND EXPERIENCE ON MORTALITY AND RE-OPERATION AT 6 MONTHS

Abstract

AIM: To investigate the relationship between patient variables and surgeons’ grade and experience on one hand and re-operation and mortality rates at six months on the other hand.

Method: Seven hundred and sixty-one patients with proximal femoral fractures (PFF) (463 intracapsular fractures, 286 extracapsular fractures, and 12 subtrochanteric fractures) were treated surgically between April 2005 to October 2007. The level of experience among trainees was quantified as the number of PFF they had fixed or replaced as the first surgeon, from the start of their training at Senior House Officer level to the beginning of the study period.

Logistic regression model was used to investigate the relationship between mortality and re-operation at six months and case mix variables (age, ASA grade, fracture types, pre-fracture residence, and mobility and activity level), and management variables (days to operation, the grade of the surgeon and supervision level). Mann-Whitney test was used to compare the level of experience among trainees in the group of patients who died or required re-operation at six months.

Results: At six months, the mortality rate was 24.2% (184) and the re-operation rate was 3.8% (29).

The logistic regression model used to predict six months mortality was highly significant (X2=166.6 [24df], p< 0.0001). It showed that age, ASA grade and pre-fracture activity level were strongly associated with mortality at six months. Patients operated on by a trainee without the consultant being scrubbed were 1.8 times (p< 0.05) more likely to die at 6 months. (Odds ratio of 1.8 with 95% confidence interval of 1.15 to 2.75). Re-operation at six months could not be predicted by these factors.

Regarding patients operated on by trainees, there was no significant difference in the level of experience among trainees who operated on patients who died or who required re-operation at six months compared to those who did not.