The ‘Best Practice Tariff‘ (BPT) was developed to improve hip fracture care by incentivising hospitals to provide timely multidisciplinary care to patients sustaining these injuries. The current literature examining the association between BPT and patient outcomes is conflicting and underpowered. We aimed to determine if achieving BPT has an impact on 30-day mortality and postoperative length of stay.

A retrospective analysis for patients admitted to a major trauma centre (MTC) was performed between 01/01/2013 to 31/12/2020. Data were extracted from the National Hip Fracture Database. The study population was divided into two groups: those who achieved all BPT criteria (BPT-passed) and those who did not (BPT-failed). The primary outcomes of interest included the 30-day mortality rate and postoperative length of stay (LOS). As a secondary objective, we aimed to assess factors that predict perioperative mortality by utilising a logistic regression model.

4397 cases were included for analysis. 3422 (78%) met the BPT criteria, whereas 973 (22%) did not. The mean LOS in the BPT-achieving group was 17.2 days compared with 18.6 in the BPT-failed group, p<0.001. 30-day mortality was significantly lower in the BPT-achieving group i.e., 4.3% in BPT-achieved vs. 12.1% in BPT-failed, p<0.001. Logistic regression modelling demonstrated that attainment of BPT was associated with significantly lower 30-day mortality (OR: 0.32; 95% CI:0.24–0.41; p<0.001).

To our knowledge, this is the largest study to investigate the association between BPT attainment and 30-day mortality as well as the length of stay. The present study demonstrates that achieving BPT in hip fracture patients is associated with a significant reduction in the average length of stay and 30-day mortality rates. Our crude calculations revealed that achieving BPT for 3422 patients earned our hospital trust >£4 million over 8 years. Findings from this study suggest that achieving BPT not only improves 30-day survival in patients with hip fractures but also aids cost-effectiveness by reducing LOS and helps generate NHS Trusts a significant amount of financial reward.

The global COVID-19 pandemic has resulted in 71 million confirmed global cases and 1.6 million deaths. Hip fractures are a major global health burden with 70 000 admissions per annum in the UK.

This multicentre UK study aimed to assess the impact of perioperative COVID-19 status on 30-day and 120-day mortality after a hip fracture.

A prospective multicentre study of 10 hospitals in South England comprising eight DGHs and two MTCs treating c.8% of the annual incidence of hip fractures in England was performed. All fragility hip fractures presenting between 1^st March to 30^th April 2020 were eligible for inclusion. COVID-19 infection was diagnosed after a positive PCR swab.

Expected 30-day mortality was calculated using the Nottingham Hip Fracture Score (NHFS), with non COVID-19 30-day mortality compared against the same study period in 2019.

746 patients were included in this study with 87 (12%) testing positive for COVID-19. Crude 30-day mortality for COVID-19 positive hip fractures was 35% compared to 6% for COVID-19 negative patients, with COVID-19 positive 30-mortality rates being significantly higher than expected based on NHFS alone (RR 3.0, 95% CI 1.57–5.75, p<0.001). There was no significant difference between expected NHFS and actual 2019 and COVID-19 negative hip fracture rates (p>0.05).

Overall 120-day mortality was significantly higher for COVID-19 positive (46%) compared to COVID-19 negative (15%) hip fractures (p<0.001). However, mortality rates from 31–120 days were not significantly different despite COVID-19 status (p=0.107).

COVID-19 results in significant increases in both 30 and 120-day mortality, above the expected mortality rates when confounding comorbidities are accounted for by the NHFS. However, COVID-19 positive patients who survive beyond 30-days have comparable mortality rates up to 120-days when compared to COVID-19 negative patients. Efforts should therefore be made to mitigate known risks for 30-day mortality such as time to theatre, to improve 30-day mortality rates in COVID-19 positive patients thus increasing the likelihood of long-term survival.

Introduction

Dislocated hip hemiarthroplasties (HA) are associated with a 45% revision rate and 40% mortality rate.

Implant selection for HA operations vary with no universally accepted implant choice. The WHiTE3 trial suggested older designs such as the Thompson has equitable outcomes to more modern and expensive implants such as the Exeter V40+Unitrax.

Our multi-centre consecutive series of NOFs patients treated with HA assesses the impact of surgical and patient factors on dislocation risk.