Projected incidence of proximal femoral fracture in England: A report from the NHS Hip Fracture Anaesthesia Network (HIPFAN)

White, Stuart; Griffiths, R.

doi:10.1016/j.injury.2010.11.010

Cited by 165 publications

(119 citation statements)

References 14 publications

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“…The global prevalence of hip fracture has been forecast to rise in line with demographic changes in population, and the median age at which patients present is currently rising in Northern Europe (by about 1 year of age every 5 years) [64]. In addition to high peri-operative mortality and morbidity, hip fracture is associated with extensive, expensive rehabilitation and loss of independence, and more commonly if patients experience delay before surgery, inadequate analgesia, blood loss, dehydration, unsympathetic anaesthesia, surgical stress, malnourishment and hypoxia, or secondary complications, such as delirium, pneumonia, cardiac failure, thromboembolism and wound infection [65].…”

Section: Hip Fracturementioning

confidence: 99%

“…There is now very strong evidence that delay from hospital admission to surgery increases mortality, lengthens hospital stay and delays functional recovery [67,68]. Delays normally relate to either organisational (51%) or medical (44%) problems, both of which are amenable to managed reduction [69]. The majority of early deaths after hip fracture surgery are attributable to pneumonia, myocardial ischaemia or heart failure [70], but there is no evidence to support pre-operative delay for medical treatment as a method of reducing mortality, possibly excepting severe (but rapidly treatable) derangements of physiology [13].…”

Section: Pre-operative Optimisationmentioning

confidence: 99%

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Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Hip Fracturementioning

confidence: 99%

Section: Pre-operative Optimisationmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…Approximately 320 000 [2] people suffer a hip fracture each year in the US, 75 000 in the UK [3]. The median age of people suffering hip fracture is 84 years and 30% have moderate-to-severe cognitive impairment when admitted to hospital, with around 1 in 12 patients dying in the next month [4].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips

2015

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SummaryWe systematically reviewed the observational associations of anaemia with outcomes and the effects of interventions to increase haemoglobin concentrations following hip fracture in older people. Anaemia on hospital admission was associated with increased mortality, relative risk 1.64 (95% CI 1.47-1.82), p < 0.0001. After adjustment for co-morbidities, the association of anaemia with increased mortality remained in four of eight observational studies. There was no association of postoperative transfusion with mortality after adjusting for covariates. Transfusion at 80 g.l À1 vs 100 g.l À1 increased acute myocardial infarction, relative risk 1.67 (95% CI 1.01-2.77), p = 0.05. Transfusion threshold was not associated with differences in other outcomes. There were insufficient high-quality studies to inform pre-operative blood transfusion or the use of peri-operative iron or erythropoietin. Studies for most interventions recruited too few participants to determine effects on infections, mortality or function.

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“…Despite this, studies that compare length of stay variables that are relatively unaffected by model of care, for example, pre-operative delay to surgery in hip fracture [16], can be used to identify good practice and indicate possible causes of poor outcome (for example, mortality after hip fracture related to prolonged pre-operative delay [17], when comparing between hospitals and longitudinally over time.…”

Section: Length Of Hospital Stay and Re-admissionmentioning

confidence: 99%

National Research Strategies: what outcomes are important in peri‐operative elderly care?

Peden

Grocott

2013

Anaesthesia

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SummaryOutcomes are essential measures of healthcare effectiveness and efficiency. Traditional measures of outcome, such as mortality and length of stay, are important and easy to measure but have significant limitations when evaluating the peri‐operative care of elderly patients. Alternative measures, including clinician‐described (e.g. complication rates, functional status, frailty) and patient‐reported outcome and experience measures, are important to provide a comprehensive description of peri‐operative outcome in the older patient. However, few measurement tools have been developed or validated specifically for the elderly surgical patient. This paper describes the outcome measures currently in use, explores how they might be used to improve the quality of care provision, and indicates priority areas for peri‐operative outcomes research in the elderly surgical patients.

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Projected incidence of proximal femoral fracture in England: A report from the NHS Hip Fracture Anaesthesia Network (HIPFAN)

Cited by 165 publications

References 14 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips

National Research Strategies: what outcomes are important in peri‐operative elderly care?

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