Suchergebnisse

Study of a group of hospital patients significantly illustrates the relationship between the accident and the psychosocial precipitating factors

The Asia-Pacific region includes countries with diverse cultural, demographic, and socio-political backgrounds. Countries such as Japan have very high life expectancy and an aged population. China and India, with a combined population over 2.7 billion, will experience a huge wave of ageing population with subsequent osteoporotic injuries. Australia will experience a similar increase in the osteoporotic fracture burden, and is leading the region by establishing a national hip fracture registry with governmental guidelines and outcome monitoring. While it is impossible to compare fragility hip fracture care in every Asia-Pacific country, this review of 4 major nations gives insight into the challenges facing diverse systems. They are united by the pursuit of internationally accepted standards of timely surgery, combined orthogeriatric care, and secondary fracture prevention strategies.

BACKGROUND: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS: We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS: Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%). INTERPRETATION: Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons. In Canada, hospitals admit 30 000 older adults with hip fracture annually.1 These patients face an increased risk of death, with up to 5% of women and 10% of men dying within 30 days.2,3 It is generally accepted that early operative intervention improves survival by reducing patients' exposure to immobilization and inflammation.4 In 2005, the federal, provincial and territorial governments established a benchmark of 48 hours from admission for 90% of hip fracture surgeries to prevent potentially harmful delays.5 However, delays to hip fracture surgery remain common.6 Patients who are medically stable at presentation may have to wait until a surgeon or an operating room becomes available.7,8 There has been considerable debate about the point at which delaying hip fracture surgery for nonmedical reasons worsens mortality.9–25 This uncertainty leads to prioritization without benefit to the patient or underuse of expeditious surgery that could prevent deaths. Some have argued that understanding the effects of policy change should guide reorganization of operating room resources26 and prioritization in the presence of competing demand.7,27–29 In this paper, we offer 2 new estimates: the effect of possible changes in surgical timing policy in the same population of patients, and the proportion of in-hospital deaths attributable to surgical delays.

Many factors affect the healthcare costs and outcomes in patients with hip fracture (HF). Through the construction of a Continuum-Care Episode (CCE), we investigated the costs of CCEs for HF and their determinants. We used data extracted from administrative databases of 5094 consecutive elderly patients hospitalized in 2017 in Emilia Romagna, Italy, to evaluate the overall costs of the CCE. We calculated the acute and post-acute costs from the date of the hospital admission to the end of the CCE. The determinants of costs by type of surgical intervention (total hip replacement, partial hip replacement, open reduction, and internal fixation) were investigated using generalized linear regression models. Regardless of the type of surgical intervention, hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds or not were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs. CCE's cost and its variability is mainly related to the rehabilitation setting. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with lower overall costs. Intermediate care organizational setting should be privileged when planning integrated care HF pathways.

Summary: The study determined the spatial temporal characteristics of fall-related hip fractures in the elderly using routinely collected injury hospitalization and sociodemographic data. There was significant spatial temporal variation in hospitalized hip fracture rates in New South Wales, Australia. Introduction: The study determined the spatial temporal characteristics of fall-related hip fractures in the elderly using routinely collected injury hospitalization data. Methods: All New South Wales (NSW), Australia residents aged 65+ years who were hospitalized for a fall-related hip fracture between 1 July 1998 and 30 June 2004 were included. Bayesian Poisson regression was used to model rates in local government areas (LGAs), allowing for the incorporation of spatial, temporal, and covariate effects. Results: Hip fracture rates were significantly decreasing in one LGA, and there were no significant increases in any LGAs. The proportion of the population in residential aged care facilities was significantly associated with the rate of hospitalized hip fractures with a relative risk (RR) of 1.003 (95% credible interval 1.002, 1.004). Socioeconomic status was also related to hospitalized hip fractures with those in the third and fourth quintiles being at decreased risk of hip fracture compared to those in the least disadvantaged (fifth) quintile [RR = 0.837 (0.717, 0.972) and RR = 0.855 (0.743, 0.989) respectively]. Conclusions: There was significant spatial temporal variation in hospitalized hip fracture rates in NSW, Australia. The use of Bayesian methods was crucial to allow for spatial correlation, covariate effects, and LGA boundary changes. © 2009 International Osteoporosis Foundation and National Osteoporosis Foundation.

Background: The economic burden of the treatment of hip fracture would be enormous, especially in countries like Iran with anaging population and limited financial resources. The choice of anesthetic technique for hip fracture surgery is controversial. Weconducted this retrospective 4 year study to evaluate the effect of regional versus general anesthesia on the length of hospital stayand the cost of hospitalization in an academic governmental setting.Methods: We reviewed the medical records of 751 adult patients who underwent a surgery for intertrochanteric or femoral neckfracture since 2008 to 2012 in a University hospital located in Tehran, Iran. Data regarding days of hospital stay and total directhospitalization costs as well as patients' demographics were analyzed based on the type of planned anesthesia. The source of datacollection was local electronic database.Results: Neuraxial anesthesia was associated with less hospital stay and costs in patients with intertrochanteric fracture surgery.The advantage of neuraxial over general anesthesia was not statistically significant in patients with femoral neck fracture.Conclusions: Neuraxial anesthesia followed by meticulous postoperative pain control may reduce the hospitalization period andcosts of hip fracture treatment. This is especially true for the patients with intertrochanteric fracture.

SUMMARY: This study investigates if the day of the week a person is admitted with a hip fracture influences the quality of care they receive. We found those admitted Thursday and Friday were likely to obtain poorer postoperative care, indicating a need to optimize services ensuring equality for all. PURPOSE: We sought to investigate how the day of admission affects the quality of care provided to hip fracture patients according to national standards (The Scottish Standards of Care for Hip Fracture Patients [SSCHFP]). METHODS: Retrospective analysis of national cohort data. Data were collected by the Scottish Hip Fracture Audit (SHFA) local audit co-ordinators (LACs) at participating Scottish hospitals on behalf of NHS Scotland and the Scottish Government. Adherence to the SSCHFP included assessment of both individual and cumulative standard attainment as a marker for quality of patient care. RESULTS: From January 2014 to April 2018, 15,351 admissions for hip fracture were recorded. Compared with Monday admission (reference day), patients admitted on a Thursday or Friday had a significantly lower likelihood of achieving the postoperative standards of prompt mobilization (OR 1.77; p < 0.001 & OR 1.48; p < 0.001, respectively); prompt physiotherapy assessment (OR 8.61; p < 0.001 & OR 3.47; p < 0.001, respectively); and prompt comprehensive geriatric assessment (OR 1.88; p < 0.001 & OR 1.41; p < 0.001, respectively). Patients admitted on a Friday or Saturday were less likely to receive the preoperative standards of no delay prior to theatre (OR 1.24; p = 0.001 & OR 1.23; p = 0.002, respectively) and avoidance of repeat fasting (OR 1.22; p = 0.009 & OR 1.22; p = 0.01, respectively). CONCLUSION: Patients admitted on Thursday or Friday were significantly more likely to not receive postoperative care standards than patients admitted on the reference day (Monday). This appears to be related to inequalities in service provision for Saturday and Sunday compared with the rest of the ...

Background: Hip fractures are common occurrence in elderly with various methods of treatment practiced for its management. Hemireplacement with different types of prosthesis is most widely practiced, and cemented bipolar prosthesis being the current trend. The aim of this study is to compare the outcome of unipolar prosthesis which is the current practice at our hospital, with the bipolar prosthesis. Methods: This was a prospective study patients aged over 65 years with displaced femoral neck or trochanteric fracture underwent hemireplacement arthroplasty, cemented unipolar prosthesis was used in 18 patients and in 16 bipolar prosthesis was used. Functional outcome using Harris Hip Score and mobility score was compared between two groups. Results: The two groups of patients did not differ in their pre-injury characteristics (age, sex,fracture pattern, ASA grading, co-morbidity, mode of injury and pre-injury ambulatory status) and peri-operative parameters such as duration of operation, blood loss, hospital stay. One year after operation, there was no statistical difference in the functional parameters such as Harris Hip Score, mobility score and rate of complication in both the groups. Conclusions: Early results suggest that Cemented unipolar prosthesis are equally effective as compared to bipolar for the treatment of displaced hip fractures in elderly patients, in Nepalese context. Key words: hip fracture; hemiarthroplasty; harris hip score. DOI: 10.3126/jnhrc.v7i2.3022 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 131-134