Aims

This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality.

Aims

This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time.

Introduction: It is well established that prompt medical management and early surgery for patients with fractured neck of femur has been shown to reduce mortality and reduce hospital length of stay. A Trauma Pathway Group (TPG) was established at Mayday Hospital, in August 2007 to assess local practises and to implement improvements, led by senior clinicians in Orthopaedics, Anaesthetics and Orthogeriatrics, and liaising with senior hospital managers within the trust. Here we present results after one year of the TPG. Means and methods: We reviewed all patients admitted to Mayday with a fractured neck of femur over 60 years of age at admission between 1st October 2006 and 31st September 2007 (prior to the TPG) and between 1st October 2007 and 31st September 2008 (after the TPG). We compared these two groups, focussing on pre-operative delays, length of stay in hospital and in-hospital mortality. Results: There were 185 patients admitted to Mayday University Hospital between 1st October 2006 and 31st September 2007, and 212 between 1st October 07 and 31st September 2008. The average age of patients admitted was 83. 75% were female. There was no significant difference in mean age or sex between the two groups. The mean wait for surgery was reduced from 4.3 days to 1.3 days (p< 0.001). The mean length of stay was reduced from 33.5 days to 26.2 (p< 0.005). The in-hospital mortality was not significantly altered - 14.6% in the first year, and 16.0% in the second. Discussion: The TPG has had a significant impact on the management of patients with fractured neck of femur. Our figures and feedback from staff and patients has been positive, and the work has increased the prominence of the care of these patients, so has enabled us to significantly improve the care of this extremely vulnerable group

Background: The implications of clinical governance, changing epidemiology, financial restraints alongside the increasing demands of the informed consumer-patient mean we must continually adapt our practice to efficiently meet expectations. As a busy regional Trauma and Orthopaedics Unit of a District General Hospital we are increasingly affected by economic agendas and have noted an increase in the presenting frailty of our fracture hip patients. Our practice has already changed by the use of an Orthogeriatrics Team (OGT): optimising patient status pre-operatively and ensuring maximum post-operatively continuity. The OGT has significantly reduced time to theatre. With appropriate investigation and lower complication rates it will offset the cost of the team. We wanted to see if the care of fractured hip patients could be further focused. On this basis, a four-part clinical stratification system was devised for patients undergoing fractured hip repair:. Complex 0 (C0): Hip repair of a non-complex fracture pattern in an otherwise fit, healthy patient. Complex I (CI): A fit, healthy patient with a complex hip fracture pattern. Complex II (CII): Medically unfit patient with a non-complex hip fracture. Complex III (CIII): Medically unfit patient with a complex hip fracture. Patients and Methods: The first 50 patients operated on across the same three months in both 2004 and 2005 were retrospectively assessed from prospectively collected data. Patients were grouped accordingly and age, length of stay, time to theatre and reason for delay, mental state examination score (MSE) on admission, and number of co-morbidities were also recorded. Chi-square was performed on co-morbidity, MSE and theatre times with AVOVA used for age and length of stay data. Results: No significant difference between groups for age. Two fold increase in stay (2004 paired classes C0+I vs CII+III; P< 0.003). Chance of more than 2 co-morbidities (C0+I vs CII+III): 52% vs 96% (2004) and 56% vs 92% (2005). MSE with a positive dementia score: 26% vs 82% (2004; P0.001) and 39% vs 70% (2005; P< 0.05). Time delays to theatre greater than 24hrs were seen 24% vs 92% (P< 0.001) in 2005. The correlating values in 2004 were 63% vs 87%. Active treatment delaying theatre in the C0+I group 24% vs 57% (CII+III) in 2004 and 0% vs 78% 2005 (P< 0.001). Conclusion: The benefit of the OGT can be seen clearly in most parameters and this classification system correlates and quantifies increasing hip fracture complexity with increasing post-operative burden even under their care. Stratifying patients for pre- and postoperative planning, risk counselling, and surgeon selection can identify patient groups likely to incur greater cost during their treatment. The classifications are easily reproducible and can be applied to larger patient groups via institutional or national joint registries