Fast track hip fracture care and mortality – an observational study of 2230 patients
Abstract Background Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. Methods Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegia...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-019-2637-6 |
| _version_ | 1819113612921274368 |
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| author | Christian Thomas Pollmann Jan Harald Røtterud Jan-Erik Gjertsen Fredrik Andreas Dahl Olav Lenvik Asbjørn Årøen |
| author_facet | Christian Thomas Pollmann Jan Harald Røtterud Jan-Erik Gjertsen Fredrik Andreas Dahl Olav Lenvik Asbjørn Årøen |
| author_sort | Christian Thomas Pollmann |
| collection | DOAJ |
| description | Abstract Background Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. Methods Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression. Results Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p < 0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15–0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis (p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63–1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group. Conclusions Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care. Trial registration The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907) 6 December 2016. |
| first_indexed | 2024-12-22T04:32:11Z |
| format | Article |
| id | doaj.art-0dd4bc22521e4c658c6de41880e2ed4a |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-22T04:32:11Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-0dd4bc22521e4c658c6de41880e2ed4a2022-12-21T18:39:00ZengBMCBMC Musculoskeletal Disorders1471-24742019-05-0120111010.1186/s12891-019-2637-6Fast track hip fracture care and mortality – an observational study of 2230 patientsChristian Thomas Pollmann0Jan Harald Røtterud1Jan-Erik Gjertsen2Fredrik Andreas Dahl3Olav Lenvik4Asbjørn Årøen5Department of Orthopaedic Surgery, Akershus University HospitalDepartment of Orthopaedic Surgery, Akershus University HospitalNorwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University HospitalInstitute of Clinical Medicine, Campus Ahus, University of OsloDepartment of Data and Analytics, Akershus University HospitalDepartment of Orthopaedic Surgery, Akershus University HospitalAbstract Background Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. Methods Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression. Results Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p < 0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15–0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis (p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63–1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group. Conclusions Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care. Trial registration The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907) 6 December 2016.http://link.springer.com/article/10.1186/s12891-019-2637-6Hip fractureFast trackMortalityReoperationSurgical site infectionAdmission time |
| spellingShingle | Christian Thomas Pollmann Jan Harald Røtterud Jan-Erik Gjertsen Fredrik Andreas Dahl Olav Lenvik Asbjørn Årøen Fast track hip fracture care and mortality – an observational study of 2230 patients BMC Musculoskeletal Disorders Hip fracture Fast track Mortality Reoperation Surgical site infection Admission time |
| title | Fast track hip fracture care and mortality – an observational study of 2230 patients |
| title_full | Fast track hip fracture care and mortality – an observational study of 2230 patients |
| title_fullStr | Fast track hip fracture care and mortality – an observational study of 2230 patients |
| title_full_unstemmed | Fast track hip fracture care and mortality – an observational study of 2230 patients |
| title_short | Fast track hip fracture care and mortality – an observational study of 2230 patients |
| title_sort | fast track hip fracture care and mortality an observational study of 2230 patients |
| topic | Hip fracture Fast track Mortality Reoperation Surgical site infection Admission time |
| url | http://link.springer.com/article/10.1186/s12891-019-2637-6 |
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