A multicenter study on definitive surgery for isolated hip fracture within 24 hours.

Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes. This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05. Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively. Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality. Therapeutic/ Care management, Level III. Copyright © 2020 American Association for the Surgery of Trauma.

Citation

Darwin Ang, Jeffrey Anglen, Michele Ziglar, John Armstrong, Patrick Offner, Mark McKenney, David Plurad, Stephen Flaherty, Ernest Gonzalez, Huazhi Liu, Mary Danish, Gregory McCormack, Julie Nash, Roger Nagy, Matthew Carrick. A multicenter study on definitive surgery for isolated hip fracture within 24 hours. The journal of trauma and acute care surgery. 2021 Jan 01;90(1):113-121

Mesh Tags

PMID: 33003017

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