Is there preventable mortality in the postoperative period of hip fracture patients?

Published Date: 21st September 2018

Publication Authors: Hamlet L, Naraen A, Roberts C

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Objective

To identify the risk factors leading to increased risk of mortality in patients with neck of femur fracture treated surgically in a district hospital in UK. 

Method

Retrospective study of records of patients with neck of femur fracture admitted between 1 January 2017 to 31 December 2017 was made. 

Results

475 patients with neck of femur fracture were admitted between January to December 2017. During the first quarter of the year, 99 patients were admitted. According to review of records, the average time to surgery was 32.2 h from the time patient presented to the Emergency Department. The 30 day mortality was 8.9% in the first quarter of 2017. The mortality then was compared within the period of August to October 2017. There was significant improvement noted in the mortality rates to 7.2%. Time to surgery was 33.6 h. 

Conclusion

Review of records revealed co-morbidities including COPD, hypertension, atrial fibrillation, diabetes mellitus and ischaemic heart disease in our patients leading to poor outcome, higher than national mortality rate, increased post-operative stay in hospital.

To help identify the risk factors and improve mortality rate and subsequently best practice tariff performance, the following implementations were made within the trust: * NOF BPT education programme * New NOF lead nurse * 5 day Ortho-Geriatrician cover * Implementation of NOAC policy * Monthly NOF forum Conclusion: The improved performance was seen within the trust with implementation of new policies. Comorbidities did play a significant role in the incidence of high mortality, but did not show any increase in avoidable mortality.

 

Naraen, A; Roberts, C; Hamlet, L. (2018). Is there preventable mortality in the postoperative period of hip fracture patients? . Osteoporosis International. 29 (Suppl 1)

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