Fast track hip fracture care and mortality – an observational study of 2230 patients

Abstract

Background Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. Methods Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression. Results Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p < 0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15–0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis ( p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63–1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group. Conclusions Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care. Trial registration The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907 ) 6 December 2016.

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

“…This result is in line with a Danish study where 30-day readmission rates were similar (ca. 12%) in fast-track group and conventional care group (LOS approximately 5 days in both groups) [26]. On the other hand, it is possible that patients who had short LOS were healthier and hence better suited for surgery and discharge without additional interventions, which could explain both LOS as well as lower 30-day readmission rate.…”

“…However, in previous studies the length of orthogeriatric intervention has ranged from days to weeks, whereas in our tertiary care center the LOS is only 1-2 days after which the patients are discharged to an orthogeriatric secondary care ward or to primary health care wards. There are some data concerning fast track hip fracture care with short postoperative hospitalization [26] but its effect on readmissions and value of geriatric contribution in the operating unit are unclear.…”

No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59,675 patients

“…The American Academy of Orthopaedic Surgeons recommends surgery within 48 hours of hospital admission (AAOS 2014). One way to attempt to decrease waiting time to surgery is to institute "fast track care" for patients with hip fracture, often consisting of attempts at early recognition of the hip fracture and thereafter expedient admission to the hospital ward, sometimes bypassing the emergency room entirely (Larsson et al 2016, Pollmann et al 2019 It is not known how, and if, waiting longer than 24 hours for surgery was associated with increased mortality compared with waiting less than 24 hours for surgery for patients with hip fractures in Sweden in recent years. It is further possible that the inconsistent results in previous studies on the risks of adverse outcomes due to prolonged waiting time to surgery may be due to different population characteristics of the study Background and purpose -Waiting time to surgery for patients with hip fractures and its potential association with mortality has been frequently studied with the hypothesis that longer waiting time is associated with adverse outcomes.…”

Assessing the Time to Ward Transfer in Patients Presenting to the Emergency Department with an Acute Hip Fracture: A Closed-loop Audit

“…Based on these observations, it is clear that there are a number of challenges that need to be overcome in order to improve compliance with BOA guideline 1, noticeably, the commencement of an integrated hip fracture care pathway. Pollmann et al describe a system in a similar institution to ours and have demonstrated ward transfer times of 1.1 hours and time to surgery of 23 hours in patients via a standardized fast track pathway through the ED to the ward [13]. Larsson et al describe a system where the patients' initial diagnostic X-ray is expedited based on paramedic assessment, and this has been shown to statistically reduce time to ward transfer [14].…”