Quality of care for patients with a fracture of the hip in major trauma centres

Metcalfe, David; Gabbe, Belinda; Perry, Daniel C.; Harris, Mitchel B.; Ekegren, Christina L.; Zogg, Cheryl K.; Salim, Ali; Costa, Matthew L.

doi:10.1302/0301-620x.98b3.36904

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…Although there was a reconfiguration of major trauma services in England (but not Scotland) from April 2012, this did not have a measurable effect on the quality of hip fracture care. 46 Second, we did not have access to some variables, such as LOS, in Scottish data and so were limited to undertaking ITSA without a control region for these outcomes. As discussed above, the absence of a control can result in erroneous attribution of change to a single intervention.…”

Section: Discussionmentioning

confidence: 99%

Pay for performance and hip fracture outcomes

Metcalfe

Zogg

Judge

et al. 2019

The Bone & Joint Journal

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Aims Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control. Materials and Methods We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay. Results There were 1 037 860 patients with a hip fracture in England and 116 594 in Scotland. Both 30-day (DID -1.7%; 95% confidence interval (CI) -2.0 to -1.2) and 365-day (-1.9%; 95% CI -2.5 to -1.3) mortality fell in England post-intervention when compared with outcomes in Scotland. There were 7600 fewer deaths between 2010 and 2016 that could be attributed to interventions driven by pay-for-performance. A pre-existing annual trend towards increased 30-day re-admissions in England was halted post-intervention. Significant reductions were observed in the time to operation and length of stay. Conclusion This study provides evidence that a pay-for-performance programme improved the outcomes after a hip fracture in England. Cite this article: Bone Joint J 2019;101-B:1015–1023.

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Section: Discussionmentioning

confidence: 99%

Pay for performance and hip fracture outcomes

Metcalfe

Zogg

Judge

et al. 2019

The Bone & Joint Journal

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“… 9 , 10 A sufficient volume of scientific data exists with regard to surgical treatment, applicable methods, and mortality. 3 , 9 In contrast, in-depth analyses regarding complications, particularly infections, are rare. 5 , 11 , 12 Furthermore, a review of national arthroplasty registries showed that revisions due to hematoma do not have priority and are not reported in many publications.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical treatment of proximal femoral fractures is predominantly performed in geriatric patients; thus, it is associated with high morbidity and mortality. 1 – 4 A variety of surgical techniques are available, including intramedullary nails, dynamic hip screws, and alloarthroplasty, the use of which depends on the patient’s age and fracture morphology. 1 – 4 Studies involving a high numbers of cases or national registries have reported revision rates of 6% to 15% and a 1-year mortality of up to 30%.…”

Section: Introductionmentioning

confidence: 99%

“… 1 – 4 A variety of surgical techniques are available, including intramedullary nails, dynamic hip screws, and alloarthroplasty, the use of which depends on the patient’s age and fracture morphology. 1 – 4 Studies involving a high numbers of cases or national registries have reported revision rates of 6% to 15% and a 1-year mortality of up to 30%. 1 , 4 – 6 However, studies regarding infections as a postoperative complication are limited, which are characterized by small case numbers and considerable “lost to follow-up.” 7 Furthermore, based on clinical experience, the reported incidence rates of 1% to 2% appear to be too low and must be challenged.…”

Section: Introductionmentioning

confidence: 99%

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Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients

Müller

Galler

Roll

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:The surgical treatment of proximal femoral fractures predominantly involves geriatric patients and is associated with high morbidity and mortality. However, analyses on postoperative infections or hematoma are rare.Methods:Patients requiring surgical revision due to infection (n = 90) or hematoma (n = 77) in the postoperative phase were identified from an electronic database of 2000 consecutive patients surgically treated for proximal femoral fractures between 2006 and 2014. Demographic and clinical data were retrieved, including information on the pathogens in patients with infection. A follow-up on morbidity and mortality was conducted via telephone for at least 2 years postsurgery.Results:The follow-up rate was 100%, and the mean age was 81.9 years. The incidence rate of infection was 4.1% (90/2000), and women were commonly affected. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly detected pathogens (35.5% and 25.5%, respectively). Mixed infections were observed in 15 patients, and Methicillin-resistant Staphylococcus aureus infections were observed in only 4 patients. A total of 77 (85.6%) infections occurred within 30 days postsurgery. The implant was preserved in 76 (84.4%) patients, and resection arthroplasty was required in 14 patients. Dementia and pertrochanteric fractures were significantly more common in the infection than in the hematoma group. Although infections were associated with high mortality rates for up to 2 years postsurgery, the rates did not significantly differ from those in the hematoma control group.Conclusion:One of every 2 patients who developed an infection following the surgical treatment of a proximal femoral fracture died within 2 years postsurgery. In addition, infections were significantly associated with dementia. Avoiding postoperative infection should be a high priority in the surgical treatment of proximal femoral fractures.

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“…They have different clinical requirements compared with major trauma patients. 13,14 While the care of these patients has not been adversely effected by the introduction of major trauma centres, 15 it remains unclear whether outcomes for hip fractures can be improved by the separation of their care into dedicated units away from the regionalised trauma centres.…”

Section: Introductionmentioning

confidence: 99%

Does a dedicated hip fracture unit improve clinical outcomes? A five-year case series

Walton

Bellringer

Edmondson

et al. 2019

annals

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Introduction The aim of the study was to establish whether a dedicated hip fracture unit, geographically separate from the local major trauma centre, could improve clinical outcomes for patients sustaining proximal femoral fragility fractures. Materials and methods This study was a retrospective case series, using data collected from Brighton and Sussex University Hospitals NHS Trust’s submissions to the National Hip Fracture Database between 1 April 2011 and 16 September 2016. The outcomes measured were mortality, length of hospital stay, time from admission to surgical intervention and return to premorbid residence. Patients were compared before and after reconfiguration of services into a separate dedicated hip fracture unit geographically distinct from the major trauma centre. Results A total of 2117 patients (2178 injuries) were managed before the existence of the hip fracture unit, while 660 patients (673 injuries) were treated within the hip fracture unit. During the five-year study period, the 30-day mortality rate (pre-hip fracture unit 5.47% vs hip fracture unit 3.13%, P = 0.014), variance in the length of hospital stay (P < 0.001), mean time to surgical intervention (P = 0.044) and return to premorbid residence were significantly improved. An immediate 12-month comparison demonstrated significantly improved variance in length of hospital stay (P = 0.020) and return to premorbid residence (P = 0.015). Discussion The reconfiguration of services significantly reduced variance in length of stay, enabling accurate resource planning in future. Multiple incremental improvements in service provision, in addition to the hip fracture unit, may explain the lower mortality observed. Conclusion While further research is required, replication of the hip fracture unit service model may potentially afford significant clinical and financial gains.

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Quality of care for patients with a fracture of the hip in major trauma centres

Abstract: There is no evidence that reconfiguring major trauma services in England disrupted the treatment of older adults with a fracture of the hip.

Cited by 17 publications

References 18 publications

Pay for performance and hip fracture outcomes

Pay for performance and hip fracture outcomes

Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients

Does a dedicated hip fracture unit improve clinical outcomes? A five-year case series

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