Changes in characteristics and outcomes of patients undergoing surgery for hip fractures following the initiation of orthogeriatric service: Temporal trend analysis

Ben Fluck, Keefai Yeong, Radcliffe Lisk, Hazel Watters, Jonathan Robin, David Fluck, Chris H Fry, Thang S Han*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
41 Downloads (Pure)

Abstract

The Blue Book published by the British Orthopaedic Association and British Geriatrics Society, together with the introduction of National Hip Fracture Database Audit and Best Practice Tariff, have been influential in improving hip fracture care. We examined ten-year (2009–2019) changes in hip fracture outcomes after establishing an orthogeriatric service based on these initiatives, in 1081 men and 2891 women (mean age = 83.5 ± 9.1 years). Temporal trends in the annual percentage change (APC) of outcomes were identified using the Joinpoint Regression Program v4.7.0.0. The proportions of patients operated beyond 36 h of admission fell sharply during the first two years: APC =  − 53.7% (95% CI − 68.3, − 5.2, P = 0.003), followed by a small rise thereafter: APC = 5.8% (95% CI 0.5, 11.3, P = 0.036). Hip surgery increased progressively in patients > 90 years old: APC = 3.3 (95% CI 1.0, 5.8, P = 0.011) and those with American Society of Anaesthesiologists grade ≥ 3: APC = 12.4 (95% CI 8.8, 16.1, P < 0.001). There was a significant decline in pressure ulcers amongst patients < 90 years old: APC =  − 17.9 (95% CI − 32.7, 0.0, P = 0.050) and also a significant decline in mortality amongst those > 90 years old: APC =  − 7.1 (95% CI − 12.6, − 1.3, P = 0.024). Prolonged length of stay (> 23 days) declined from 2013: APC =  − 24.6% (95% CI − 31.2, − 17.4, P < 0.001). New discharge to nursing care declined moderately over 2009–2016 (APC =  − 10.6, 95% CI − 17.2, − 2.7, P = 0.017) and sharply thereafter (APC =  − 47.5%, 95%CI − 71.7, − 2.7, P = 0.043). The rate of patients returning home was decreasing (APC =  − 2.9, 95% CI − 5.1, − 0.7, P = 0.016), whilst new discharge to rehabilitation was increasing (APC = 8.4, 95% CI 4.0, 13.0; P = 0.002). In conclusion, the establishment of an orthogeriatric service was associated with a reduction of elapsed time to hip surgery, a progressive increase in surgery carried out on high-risk adults and a decline in adverse outcomes.

Original languageEnglish
Pages (from-to)185-195
Number of pages11
JournalCalcified Tissue International
Volume110
Issue number2
Early online date27 Aug 2021
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • mortality
  • length of stay
  • discharge destination
  • join-point analysis
  • temporal trends

Fingerprint

Dive into the research topics of 'Changes in characteristics and outcomes of patients undergoing surgery for hip fractures following the initiation of orthogeriatric service: Temporal trend analysis'. Together they form a unique fingerprint.

Cite this