Abstract
The 2011 National Hip Fracture Database (NHFD) Report has shown our institute has the fewest number of patients meeting the 36-hour target to theatre in the UK (9%) but well above the national average for review by geriatrician (42.5%) at 76%. We believe our timely medical input means patients' are more physiologically normalised prior to surgery. We aimed to review our postoperative results to see if our patients had significantly different morbidity and mortality compared to the rest of the UK.
We reviewed 152 patients between the period September 2009 and September 2010. All of the patients were prospectively identified and their information was added to our hip fracture database. Using the auditing software we reviewed the patients' outcomes and compared them to national averages using figures from the NHFD.
Of the 152 patients identified 13% met the 36-hour target. The average time to theatre for the study group was 89 hours. 83% of the group had a pre-operative assessment by a geriatrician. The primary reason for surgical delay was a lack of space on a theatre list (61.2%) followed by being medical unfit (16.4%). The average length of acute hospital stay was 16.4 days matching the national average while 30 Day mortality at 7.9% was (0.5%) lower than NHFD figures.
We continue to try and improve our time to surgery for hip fracture patients and accept this is mostly related to limited theatre access. Deficient resources due to Northern Ireland's exclusion from the best practice tariff means we are unable to compete with the top performing units in the NHFD. While it makes humanitarian sense to expedite surgery, evidence used to determine the 36-hour target is quoted as “low quality” or “very low quality”. Our data shows no significant difference in outcomes compared to national figures.
