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Wang Z, Chen M, Luo X, Xiong X, Ma F. Effectiveness of optimised care chain for hip fractures in elderly Chinese. Int J Health Plann Manage 2021; 36:1445-1464. [PMID: 34519092 DOI: 10.1002/hpm.3261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report. METHODS We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis. RESULTS This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC. CONCLUSIONS This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.
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Affiliation(s)
- Zhaofu Wang
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Meixue Chen
- School of Nursing, Jinan University, Guangzhou, China
| | - Xiaohai Luo
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Xianghua Xiong
- School of Surgery, Ningxia Medical University, Yinchuan, China
| | - Feng Ma
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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Bartra A, Caeiro JR, Mesa-Ramos M, Etxebarría-Foronda I, Montejo J, Carpintero P, Sorio-Vilela F, Gatell S, Canals L. Cost of osteoporotic hip fracture in Spain per Autonomous Region. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bennett A, Li H, Patel A, Kang K, Gupta P, Choueka J, Feierman DE. Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay. Geriatr Orthop Surg Rehabil 2018; 9:2151459318795260. [PMID: 30245906 PMCID: PMC6146322 DOI: 10.1177/2151459318795260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group (P = .0002) and 2.26 compared to the ASA 3 group (P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours (P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 (P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 (P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.
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Affiliation(s)
- Andrew Bennett
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Hsin Li
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aakash Patel
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin Kang
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Piyush Gupta
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jack Choueka
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dennis E Feierman
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
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Molina Hernández MJ, González de Villaumbrosia C, Martín de Francisco de Murga E, Alarcón Alarcón T, Montero-Fernández N, Illán J, Bielza R, Mora-Fernández J. [Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]. Rev Esp Geriatr Gerontol 2018; 54:5-11. [PMID: 30131189 DOI: 10.1016/j.regg.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. MATERIAL AND METHOD This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). RESULTS The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. DISCUSSION Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.
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Affiliation(s)
| | | | | | | | - Nuria Montero-Fernández
- Servicio de Geriatría, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Julia Illán
- Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Rafael Bielza
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jesús Mora-Fernández
- Servicio de Geriatría, IdISSC, Hospital Universitario Clínico San Carlos, Madrid, España.
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Bartra A, Caeiro JR, Mesa-Ramos M, Etxebarría-Foronda I, Montejo J, Carpintero P, Sorio-Vilela F, Gatell S, Canals L. Cost of osteoporotic hip fracture in Spain per Autonomous Region. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:56-68. [PMID: 29793855 DOI: 10.1016/j.recot.2018.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/07/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.
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Affiliation(s)
- A Bartra
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - J-R Caeiro
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - M Mesa-Ramos
- Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España
| | | | - J Montejo
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - F Sorio-Vilela
- Amgen S.A., World Trade Center Barcelona, Barcelona, España
| | - S Gatell
- Amgen S.A., World Trade Center Barcelona, Barcelona, España
| | - L Canals
- Amgen S.A., World Trade Center Barcelona, Barcelona, España
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Haugan K, Johnsen LG, Basso T, Foss OA. Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care. BMJ Open 2017; 7:e015574. [PMID: 28851773 PMCID: PMC5724094 DOI: 10.1136/bmjopen-2016-015574] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/08/2017] [Accepted: 07/26/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare the efficacies of two pathways-conventional and fast-track care-in patients with hip fracture. DESIGN Retrospective single-centre study. SETTING University hospital in middle Norway. PARTICIPANTS 1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric). INTERVENTIONS 788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013. PRIMARY AND SECONDARY OUTCOME Primary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay. RESULTS We found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways. CONCLUSIONS There was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased. TRIAL REGISTRATION NUMBER NCT00667914; results.
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Affiliation(s)
- Kristin Haugan
- Department of Orthopaedics, Orthopaedic Research Centre, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lars G Johnsen
- Department of Orthopaedics, Orthopaedic Research Centre, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Trude Basso
- Department of Orthopaedics, Orthopaedic Research Centre, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A Foss
- Department of Orthopaedics, Orthopaedic Research Centre, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Factors influencing radiation exposure during internal fixation of hip fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:637-641. [PMID: 28396949 DOI: 10.1007/s00590-017-1951-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Abstract
The use of fluoroscopy is of great importance for operative fixation of fractures. Previous studies have shown an increased fluoroscopy time for intramedullary nails and with junior surgeons in comparison with more experienced surgeons. We examined the impact of operation length on fluoroscopy dose, cumulative fluoroscopy time between consultant and registrar surgeons and cumulative fluoroscopy time between dynamic hip screw and intramedullary nailing. We performed a retrospective cohort study of all patients admitted to our centre over the period of 1 year. Patients who underwent dynamic hip screw (DHS) or intramedullary (IM) nailing were identified from our in-hospital hip fracture database. Intraoperative fluoroscopy images were then accessed through our hospital's medical imaging software. A total of 137 patients were identified. Fluoroscopy reports were not available for 49 patients, resulting in a final total of 88 patients. Patients whose operation lasted longer than 1 h received a statistically significant higher dose of radiation (183.83 cGYM2 vs. 368.22 cGYM2; p value 0.0002). Operations performed by a consultant resulted in less cumulative fluoroscopy time in comparison with those performed by a registrar or specialist registrar although this was not statistically significant (00:00:53 vs. 00:00:45; p vaue 0.38). Cumulative fluoroscopy time was less in dynamic hip screw compared to long intramedullary nails (00:00:39 vs. 00:01:29; p value <0.001) and short intramedullary nails (00:00:39 vs. 00:01:52; p value 0.387). Studies, which had a cumulative fluoroscopy time exceeding 50 secs, delivered a higher radiation dose (434.34cGYM2 vs. 150.51cGYM2; p value <0.001). We concluded that there is no significant impact in cumulative fluoroscopy time in operations performed by either a registrar or consultant. Dynamic hip screws have a lower fluoroscopy time in comparison with long intramedullary nails.
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