1
|
López-Martín N, Escalera-Alonso J, Thuissard-Vasallo IJ, Andreu-Vázquez C, Bielza-Galindo R. [Result of the update of the clinical pathway for hip fracture in the elderly at a university hospital in Madrid]. Rev Esp Geriatr Gerontol 2023; 58:61-67. [PMID: 36804952 DOI: 10.1016/j.regg.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge. MATERIAL AND METHOD A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year. RESULTS Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year. CONCLUSIONS Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
Collapse
Affiliation(s)
- Néstor López-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - Javier Escalera-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Israel John Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Cristina Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Rafael Bielza-Galindo
- Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| |
Collapse
|
2
|
Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry. Arch Osteoporos 2022; 17:54. [PMID: 35332414 DOI: 10.1007/s11657-022-01084-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/23/2022] [Indexed: 02/03/2023]
Abstract
This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.
Collapse
|
3
|
Ríos-Germán PP, Gutierrez-Misis A, Queipo R, Ojeda-Thies C, Sáez-López P, Alarcón T, Puime AO, Gómez-Campelo P, Navarro-Castellanos L, González-Montalvo JI. Differences in the baseline characteristics, management and outcomes of patients with hip fractures depending on their pre-fracture place of residence: the Spanish National Hip Fracture Registry (RNFC) cohort. Eur Geriatr Med 2021; 12:1021-1029. [PMID: 33970467 DOI: 10.1007/s41999-021-00503-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture. METHODS We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up. RESULTS Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%). CONCLUSION Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.
Collapse
Affiliation(s)
- Peggy P Ríos-Germán
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain. .,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - Alicia Gutierrez-Misis
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rocío Queipo
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,European University of Madrid, Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Pilar Sáez-López
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Geriatric Medicine, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Teresa Alarcón
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Angel Otero Puime
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Gómez-Campelo
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Juan Ignacio González-Montalvo
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | |
Collapse
|
4
|
González de Villaumbrosia C, Sáez López P, Martín de Diego I, Lancho Martín C, Cuesta Santa Teresa M, Alarcón T, Ojeda Thies C, Queipo Matas R, González-Montalvo JI. Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073809. [PMID: 33917348 PMCID: PMC8038738 DOI: 10.3390/ijerph18073809] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022]
Abstract
The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.
Collapse
Affiliation(s)
| | - Pilar Sáez López
- Hospital Universitario Fundación Alcorcón, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Isaac Martín de Diego
- Data Science Lab, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (I.M.d.D.); (C.L.M.); (M.C.S.T.)
| | - Carmen Lancho Martín
- Data Science Lab, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (I.M.d.D.); (C.L.M.); (M.C.S.T.)
| | | | - Teresa Alarcón
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain; (T.A.); (J.I.G.-M.)
| | | | | | - Juan Ignacio González-Montalvo
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain; (T.A.); (J.I.G.-M.)
| | | |
Collapse
|
5
|
Castillón P, Nuñez JH, Mori-Gamarra F, Ojeda-Thies C, Sáez-López P, Salvador J, Anglés F, González-Montalvo JI. Hip fractures in Spain: are we on the right track? Statistically significant differences in hip fracture management between Autonomous Communities in Spain. Arch Osteoporos 2021; 16:40. [PMID: 33624180 DOI: 10.1007/s11657-021-00906-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/02/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although medicine is currently protocol-based, there are still differences in the management of the hip fracture in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations. This data will be of great value to assist stakeholders in formulating health policies. PURPOSE Analysis of demographic, clinical, surgical, and functional data of the Spanish National Hip Fracture National Registry (RNFC), during admission and at 1-month follow-up, by Autonomous Communities (ACs). METHODS Cross-sectional analysis in the framework of a RNFC cohort, from January 2017 to May 2018, including 15 ACs from Spain, with 1 month of follow-up. Sociodemographic, clinical, surgical, and outcome variables were analyzed. RESULTS In total, 13,839 patients were analyzed. There were significant differences (p <0.001) in median surgical delay and percentage of patients operated in less than 48 h. Mean surgical delay was 70.75 h, with a 12-h difference between the Communities of Madrid (71.22) and Catalonia (59.65). Only 43% of patients had less than 48-h delay. Overall, most patients received regional anesthesia (91.9%); however, there was a significant difference between ACs (p = 0.0001). There were also differences in inpatient stay, early mobilization, discharge destination, and mortality (p <0.001). Mortality 30 days after surgery was 7.8%, and highest in the Basque Country (12.5%). CONCLUSIONS The registry showed homogeneity among ACs regarding sociodemographic variables, fracture type, surgical treatment, ASA risk, and co-management with a geriatrician or an integrated internist. There were significant differences in hip fracture management between ACs in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations.
Collapse
Affiliation(s)
- Pablo Castillón
- Department of Traumatology and Orthopaedic Surgery, University Hospital of Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Jorge H Nuñez
- Department of Traumatology and Orthopaedic Surgery, University Hospital of Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain. .,Department of Traumatology and Orthopaedic Surgery, University Hospital of Vall d' Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain.
| | - Fatima Mori-Gamarra
- Complexo Hospitalario Universitario de Ourense, Calle Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, University Hospital of 12 de Octubre, Av. Córdoba s/n, 28041, Madrid, Spain
| | - Pilar Sáez-López
- Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain.,Hospital Universitario Fundación Alcorcón, Madrid, Spain.,Spanish National Hip Fracture Registry, Madrid, Spain
| | - Jordi Salvador
- Department of Traumatology and Orthopaedic Surgery, University Hospital of Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Francesc Anglés
- Department of Traumatology and Orthopaedic Surgery, University Hospital of Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.,Departament de Cirurgia Universitat de Barcelona, Barcelona, Spain
| | - Juan Ignacio González-Montalvo
- Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain.,Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | |
Collapse
|
6
|
Ojeda-Thies C, Brent L, Currie CT, Costa M. Fragility Fracture Audit. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-48126-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
|