Sind Prozessänderungen messbar? Eine Analyse über 16 Jahre mit 4163 proximalen Femurfrakturen

Abstract

Process changes in the perioperative setting are rarely analysed, as their results are not immediately tangible and require a high case volume. The primary objective of this study was to retrospectively evaluate process changes using proximal femur fractures (PFF) and to examine their effect using various outcome measures. The secondary objective was to define potential quality criteria for the management of PFF.This study included a retrospective analysis of the database of a level-1 trauma centre for PFF. All PFF treated with osteosynthesis and endoprosthesis during the treatment period from 1 January 2006 to 31 December 2021, were included. The 16-year period was trichotomously divided for statistical analysis, and the first 6 years were used as the baseline. A total of 10 process changes were implemented in the subsequent 10 years. The impact of these changes was assessed using operative revision rate, infection rate, perioperative transfusion rate, and 1-year mortality.A total of 4,163 PFF were analysed. Regarding the outcome measures, changes in the first 5 years (2012–2016; intramedullary procedures for osteosynthesis and use of disposable drape and gown) showed the most significant effect, with sustained reduction in long-term surgical revision rate of < 10%. Further process optimisations over the past 5 years (2017–2021) also yielded measurable improvements (reduction in infection and transfusion rates). The 1-year mortality remained unchanged, even during the COVID-19 pandemic.Process changes in PFF do not immediately lead to objectively measurable improvements. In retrospect, the paradigm shift from extra- to intramedullary osteosynthesis appears to have the greatest effect, although gradual improvements were noted in all outcome measures over the past 10 years, except for mortality. An objective quality control target should aim for a 1-year revision rate of < 10%.