Aims

Current levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care.

Aims

The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients.

Background. National hip fracture programmes are becoming widespread, but this practice is nascent and varied. The Scottish Hip Fracture Audit (SHFA) was an early adopter of this strategy and is credited with substantial systemic improvements in quality and outcomes. Objectives. To provide evidence and incentive to clinicians and administrators to adopt successful improvement strategies, and to facilitate data-driven change hip fracture care. Study Design and Methods. We reviewed the practice of seven national hip fracture improvement programmes in: Sweden, Denmark, Norway, Australia, New Zealand, UK, Scotland, and Ireland. We report our experience from the SHFA and describe: the results of our programme; challenges and learning points encountered, and successful strategies for implementing change. Results. There is variance in approach to data collection and reporting, for example: standalone programmes versus combined trauma and arthroplasty registries; annual trend reporting versus ‘snapshot’ or real-time information; population-level versus patient-level data, and the emphasis placed on service-level characteristics. The governance model also varies – some act as a passive data registry whereas others act as active agents of change and regulation. There is consensus on the key performance makers: prompt admission; early surgery and mobilisation, and a multidisciplinary approach. There have been significant challenges encountered by the SHFA with respect to funding, logistical, and political issues. Analysis of the effects of our programme have demonstrated its clinical efficacy, and has identified successful strategies for improvement. We describe this experience. Conclusions. The establishment of national audit programmes has resulted in significant improvements in quality, efficiency, and outcomes. This study of major national programmes provides evidence, incentive, and instruction to clinicians and administrators who seek to improve healthcare systems

BACKGROUND. Since 1996, the Scottish Hip Fracture Audit (SHFA) group have published reports on the outcomes of patients with hip fractures. In the 2008 report, the group outlined the target standard that “98% of medically fit patients who have sustained a hip fracture should be operated on within 24 hours of ‘safe operating time’ (i.e. between 8 am and 8pm, seven days a week).”. 1. . AIM. We aim to investigate the compliance of our unit to the SHFA target standard. METHODS. We prospectively examined patients who were admitted with hip fractures between 1. st. April to 31. st. July 2011. These included admissions from A&E and inpatients. Patients who did not receive surgical treatment were excluded. Information was collected using the same pro forma as the SHFA group. RESULTS. There were 72 patients with hip fractures in that period. One patient (1.4%) was considered unfit for surgery and therefore excluded. Sixty-five patients were considered fit for surgery on first assessment and 61 (93.8%) had surgery within the target time. There were three patients (4.6%) whose diagnosis was delayed waiting for MRI. The waiting period included a weekend in two patients, when there were no MRI facilities. Only one patient (1.5%) had surgery delayed due to lack of theatre availability. DISCUSSION. Having surgery performed as early as possible is associated with a beneficial impact on morbidity, complications and length of hospital stay. 2–4. , reflected with SIGN guidelines stating “surgery should be performed as soon as the medical condition allows”. 5. and NICE recommending surgery within 48 hours of admission. 6. . CONCLUSION. Although our rate of 93.8% does not meet the target standard, it represents an improvement from the published rate (91.2%) in 2008. It also highlights the areas for improvement in patient care, particularly in getting MRIs swiftly to avoid delays

Background. Hip fracture in the elderly has high morbidity and mortality. National guidelines have recommended low molecular weight (LMW) heparin or aspirin for thromboprophylaxis in hip fracture. Unlike other types of major surgery, there is a lack of trial evidence for graduated elasticated compression (GEC) stockings in hip fracture patients. Objective. To explore the effect of thromboprophylaxis on survival in hip fracture patients. Participants. 8470 Scottish Hip Fracture Audit (SHFA) participants aged 60 years and over, admitted 1998-2003. Methods. SHFA records were linked to routinely collected hospital discharge and death records occurring within one year of hip fracture admission. Cox proportional hazards regression was used to adjust for age, gender, previous hospital admissions, previous walking ability and residence, American Society of Anesthesiologists grade, fracture type, pressure sores prior to surgery, and delay to surgery. Results. 2531 (30%) patients died within one year of hip fracture admission. GEC stockings appeared to be protective against death (hazard ratio 0.88, 95% confidence interval 0.80-0.97) as did aspirin (HR 0.85, 95% CI 0.76-0.95). However heparin did not appear to protect against death (HR 0.97, 95% CI 0.87-1.08), even when only LMW heparin was included in the analysis. Overall, 3318 (39%) patients were given GEC stockings, 2735 (32%) aspirin, and 4527 (53%) heparin. Patients commonly received more than one type of thromboprophylaxis. Conclusions. This study provides evidence for a protective effect of GEC stockings and aspirin following hip fracture, but not heparin. The study design allowed sophisticated analysis, adjusting for a number of functional, social, surgical, anaesthetic and medical factors. The findings may however be explained by other confounding factors not included in the analysis. These findings suggest that a randomised controlled trial of GEC stockings, aspirin and heparin in hip fracture patients is warranted

Aims

The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture.

Aims

Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients.

Aims

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality.

Aims

Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.

Aims

The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission.

Aims

The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures.

We have investigated how medical postponement, the time to surgery and the correction of medical abnormalities, according to McLaughlin criteria, before operation affected peri-operative mortality after fracture of the hip. From February to December 2007, in addition to core data, the Scottish Hip Fracture Audit collected information relating to surgical delay. Data were available for 4284 patients which allowed 30-day survival analysis to be performed. Multivariable logistic regression models were used to control for differences in case-mix.

Patients with major clinical abnormalities were more likely to have a postponement and had a lower unadjusted 30-day survival. The time to operation and postponement were not associated with higher mortality after adjustment for case-mix. Correction of major clinical abnormalities before surgery improved the adjusted survival, but this improvement was not significant (p = 0.10). Postponement without correction of a medical abnormality before surgery was associated with a significantly lower (p = 0.006) 30-day adjusted survival. The possible benefits of postponement need to be weighed against prolonged discomfort for the patient and the possibility of the development of other complications.