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Tabu IA, Araneta KTS, Alpuerto BB, Delgado GD, Lai JGL, San Juan JAG, Ho A, Reyes MRB, De Vera J, Syquia JFC, Manalastas REC, Tablante AJC, Brabante AMT, Dimayuga CCD, Pacheco DM, Baclig PY, Co AST, Yap JAD. Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic. BMJ Open Qual 2023; 12:e002299. [PMID: 37783523 PMCID: PMC10565130 DOI: 10.1136/bmjoq-2023-002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/12/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.
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Affiliation(s)
- Irewin A Tabu
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Institute on Aging, National Institutes of Health, UP Manila, Philippines
| | | | - Bernardino B Alpuerto
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Giorgio D Delgado
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Joseph Garvy L Lai
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Department of Orthopedics, Cardinal Santos Medical Center, San Juan, Philippines
| | | | - Alexander Ho
- Department of Orthopedics, Chong Hua Hospital, Cebu City, Philippines
| | - Ma Ramona B Reyes
- Department of Orthopedics, Davao Doctors Hospital, Davao City, Philippines
| | - Jose De Vera
- Department of Orthopedics, De Los Santos Medical Center, Quezon City, Philippines
| | | | | | | | | | - Cesar Cipriano D Dimayuga
- Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines
- Department of Orthopedics, The Medical City, Pasig City, Philippines
| | - Deejay M Pacheco
- Department of Orthopedics, Veterans Memorial Medical Center, Quezon City, Philippines
| | - Phillipe Y Baclig
- Department of Orthopedics, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Andrew Steven T Co
- Department of Orthopedics, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - John Alfred D Yap
- Department of Orthopedics, West Visayas State University Medical Center, Iloilo City, Philippines
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