The Relationship Between Short‐Term Mortality and Quality of Care for Hip Fracture: A Meta‐Analysis of Clinical Pathways for Hip Fracture

Neuman, Mark D.; Archan, Sylvia; Karlawish, Jason; Schwartz, Jamie; Fleisher, Lee A.

doi:10.1111/j.1532-5415.2009.02492.x

Cited by 59 publications

(42 citation statements)

References 29 publications

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“…The total complication rates were comparable with rates found in literature [19]. The safety of implementing a clinical pathway for hip fractures is further supported by a meta-analysis of nine studies (involving 4,637 patients), focusing on co-morbidities and postoperative complications [20]. It was found that complications during hospitalization in patients with hip fractures treated in a clinical pathway were less prevalent.…”

Section: Discussionsupporting

confidence: 60%

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Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Burgers

Lieshout

Verhelst

et al. 2013

International Orthopaedics (SICOT)

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Purpose Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery. Methods This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N =212), and the second was from January 7, 2010 to July 7, 2011 (N =314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions. Results In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p <0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p <0.001); for internal fixation there was no significant difference (five versus six days, p =0.557) and after Gamma nailing it decreased from ten to six days (p <0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p =0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p =0.049). Readmissions for the total group were not different (16 % versus 17 %, p =0.720).Conclusions Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.

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Section: Discussionsupporting

confidence: 60%

“…However, the 30-day mortality rates (6 % versus 5 %) are in accordance with those from the meta-analysis. The combined in-hospital/30-day mortality was reported to be 8 % (118 of out 1,520 patients) in the pathway group and 9 % (141 out of 1,522 patients) in the non-pathway group [20].…”

Section: Discussionmentioning

confidence: 99%

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Burgers

Lieshout

Verhelst

et al. 2013

International Orthopaedics (SICOT)

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“…The 30-day mortality rate in our study was generally much lower than the commonly quoted figures, ranging from 5.1% to 13%. 6,9,11,15,[18][19][20] Although there is no statistical significance in the mortality rate before and after the clinical pathway, it definitely showed a decreasing trend despite increasing the number of hip fractures with increasing number of comorbidities. Regular yearly audit of the performance and the clinical outcomes is another important aspect leading to the early success and the sustainability of this clinical pathway for the past 5 years.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

Lau

Fang

Leung

2013

Geriatr Orthop Surg Rehabil

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Background: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. Methods: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. Results: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. Conclusion: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability.

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“…A partir del conocimiento exhaustivo y real de la problemática de nuestro hospital, y de la revisión de las alternativas 11,13,15,18,19 , se ha definido la necesidad de un plan de actuación multidisciplinario, de atención integral e individualizada a los pacientes con fractura de fémur que se está implementando en la actualidad. El objetivo es disminuir las complicaciones postoperatorias, la estancia media hospitalaria, la mortalidad postoperatoria y mejorar la funcionalidad de los pacientes después de la cirugía.…”

Section: Discussionunclassified

“…Para disminuir la morbimortalidad postoperatoria y la estancia hospitalaria, es necesario optimizar el estado de salud previo a la cirugía, prevenir las complicaciones y aportar durante todo el proceso hospitalario el tratamiento hospitalario más adecuado 11,13,17,18 .…”

Section: Introductionunclassified

Factores pronóstico de mortalidad en los pacientes mayores con fractura de cadera

Reguant

Bosch

Montesinos

et al. 2012

Revista Española de Anestesiología y Reanimación

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The Relationship Between Short‐Term Mortality and Quality of Care for Hip Fracture: A Meta‐Analysis of Clinical Pathways for Hip Fracture

Cited by 59 publications

References 29 publications

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

Factores pronóstico de mortalidad en los pacientes mayores con fractura de cadera

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