Impact of multidisciplinary hip fracture program on timing of surgery in elderly patients

Ventura, Chiara; Trombetti, Susanna; Pioli, Giulio; Belotti, Laura Maria Beatrice; Palma, Rossana De

doi:10.1007/s00198-014-2803-5

Cited by 24 publications

(20 citation statements)

References 28 publications

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“…In particular, the time to surgery depends on the treating hospital type [36][37][38] and its available resources, including operating rooms, [39][40][41][42] nursing staff, 43 surgeons, 39 specialists 23,44 and laboratory tests 23,41,44 Resource availability depends on the time of admission, with resources being less available "after hours" than during regular working hours. 42,[45][46][47] The risk also depends on the type of surgery itself, because arthroplasty requires additional resources, such as a surgeon with arthroplasty experience and implants that may not be kept in stock. 3,23 The risk of a delay to surgery also depends on the overall demand for services, which may exceed available resources.…”

Section: Dependency Graphmentioning

confidence: 99%

“…62 Furthermore, the risk of in-hospital death depends on the length of time spent in hospital, which in turn depends on the presence (or absence) of early discharge policies. 3 The risk of death may also depend on where patients undergo treatment, 37,38 because of between-hospital differences in quality of care, 20 intensity of care, 63 clinical pathways, 42,64 and care standards. 20,65 [Insert Figure 1 and Table 1 here]…”

Section: Dependency Graphmentioning

confidence: 99%

“…First, hospital type produces variation in time to surgery through resource availability, 23,36,[38][39][40][41][42][43][44] and variation in postoperative in-hospital death through quality of care, intensity of care, clinical pathways, and care standards. 20,37,38,42,63,65 Second, surgery type produces variation in time to surgery through resource availability, 3,23 and also produces variation in postoperative in-hospital death. 24,25 Other dependencies Figure 2 shows other dependencies among the factors that influence timing of surgery and postoperative in-hospital death, as described in Table 2.…”

Section: Common Factorsmentioning

confidence: 99%

“…Limited operating room availability is associated with a surgical delay. [39][40][41][42] Higher levels of nurse staffing improve operating room availability and shorten the time to surgery. 43 Lack of availability of surgeons is associated with a delay to surgery.…”

Section: Process Resource Availabilitymentioning

confidence: 99%

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Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.

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Section: Dependency Graphmentioning

confidence: 99%

Section: Dependency Graphmentioning

confidence: 99%

Section: Common Factorsmentioning

confidence: 99%

Section: Process Resource Availabilitymentioning

confidence: 99%

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Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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“…El artículo de Sáez et al publicado en este número de la revista pone de manifiesto los beneficios de la protocolización del tratamiento interdisciplinar del anciano con fractura de cadera, demostrando su enorme repercusión en mortalidad y estancia hospitalaria en concordancia con otros estudios recientes [6][7][8] . Los protocolos de intervención diseñados tras una exhaustiva revisión bibliográfica 9 abordan los problemas más prevalentes en la cirugía por fractura de cadera y la investigación previamente desarrollada para su puesta en marcha debe ser el objetivo común de los profesionales dedicados a la ortogeriatría en la actualidad 10,11 .…”

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Utilidad de las vías clínicas en el tratamiento del anciano con fractura de cadera

Sierra

2015

Revista Española de Geriatría y Gerontología

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The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story?

Sermon

Rochus

Smeets³

et al. 2018

Eur J Trauma Emerg Surg

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Background Timing of surgery in geriatric hip fracture treatment remains controversial. Early surgery is acknowledged as quality indicator and NICE guidelines recommend surgery within 0 to 48 hours from admission. In 2014 we implemented the indicator early surgery in our institution, enhancing operative treatment within the next calendar day. We aimed to evaluate the implementation, define the room for improvement and provide strategies to maintain the quality indicator. Methods Clinical outcome of 744 patients (January 2011 -December 2013) before early surgery was implemented, was compared to 817 patients (June 2014 -May 2017) after implementation of early surgery with a follow-up of 6 months. Data-analysis was done by Pearson's Chi-square test and MannWhitney U test. Results Early surgery was achieved in 47.6% and 85.7% in the preimplementation and postimplementation group, respectively (P < 0.001). Both 30-days and 6-months mortality were similar (6.0% vs. 5.4%, P = 0.573 and 18.7% vs. 16.9%, P = 0.355, preimplementation vs. postimplementation, respectively). Early surgery resulted in a significantly shorter total length-of-stay (14 vs. 12 days, P < 0.001, preimplementation vs. postimplementation, respectively). Early surgery did not reduce the readmission rate. Conclusions The indicator early surgery has been successfully implemented. Early surgery resulted in a significantly shorter LOS. No significant reduction in 30-days and 6-months mortality, and 90-days readmission was observed. In order to maintain early surgery, continuous engagement and monitoring is required by all shareholders involved and if necessary, adjustment of the clinical route is appropriate.

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Impact of multidisciplinary hip fracture program on timing of surgery in elderly patients

Abstract: Several modifiable organizational factors may affect the proportion of patients with hip fracture undergoing early surgery. This study suggests that the development and the implementation of an evidence-based HFP at trust level are a key point of the strategy of quality of care.

Cited by 24 publications

References 28 publications

Mortality by Timing of Hip Fracture Surgery

Mortality by Timing of Hip Fracture Surgery

Utilidad de las vías clínicas en el tratamiento del anciano con fractura de cadera

The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story?

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