[Development of the inpatient quality of care of surgically treated patients with a proximal femoral fracture in North Rhine-Westphalia : Analysis of 61,249 treatment courses based on data from external inpatient quality assurance].

Background And Objective: Every year in Germany over 100,000 people, mostly of older age, suffer a proximal femoral fracture. Increasing case numbers in connection with an aging population and a relatively large number of concomitant diseases requiring treatment make everyday care more difficult. It is therefore of great importance to observe the quality of care for these patients using relevant quality parameters in order to be able to derive implications for everyday treatment practice.

[Osteosynthetic treatment of proximal femoral fractures: the timing of treatment is delayed in cases of pre-existing anticoagulation : Results of the data of external inpatient quality assurance from North Rhine-Westphalia with 24,786 cases within the framework of using secondary data].

Background And Objective: Proximal femoral fractures are common in Germany with approximately 100,000 affected patients per year. The mortality could be considerably reduced by timely treatment (<24 h). The objectives of this work were to demonstrate the prevalence of anticoagulation and associated complications in osteosynthetically treated proximal femoral fractures, the impact of anticoagulation on the preoperative period and potential optimization of perioperative anticoagulation management.

[Subtrochanteric femur fractures-epidemiology, surgical procedures, influence of time to surgery and comorbidities on complications : A risk-adjusted regression analysis of routine data from 2124 cases].

Background: There are approximately 12,000 subtrochanteric femur fractures in Germany per year with a rising trend but studies about the epidemiology and the surgical outcome are rare. Furthermore, there are no guidelines from expert societies and there is no adequate quality assurance.

Objective: Presentation of the epidemiology and the current treatment situation with respect to the patient collective, comorbidities, time to surgery and surgical procedures used as well as the identification of modifiable risk factors with respect to complications.

[More patients in a shorter inpatient stay with better outcome in treatment of femoral neck fracture: external quality assurance in Westfalia-Lippe on 50,354 patients].

Background: We show a comparison between two patient groups of the inpatient population suffering from femoral neck fractures registered in the external quality assurance between 1993 and 1997 and between 2005 and 2009.

Results: The comparison between two patient groups showed the following developments: an increase in patient numbers per year from 4,229 to 5,842 where the average age remained constant but the proportion of elderly patients over 70 years old increased; the period of hospitalization was clearly shorter (from 27 days to 18 days); an increase in comorbidities (according to the ASA classification) with simultaneous decrease of the complication rate (from 11.1% to 7.

[One-year outcomes for proximal femoral fractures: Posthospital analysis of mortality and care levels based on health insurance data].

Background: Proximal femur fractures are common and treatment is expensive. The aim of the present study was - after matching of hospital and health insurance data - to evaluate the influence of early operation on certain outcome parameters. Data from a German health insurance were used to identify then influence of the day of operation after admittance on the rate of mortality, decubitus, and revision surgery during the hospital stay and on the care level of the patients up to 1 year and in some cases longer after operation.

[Medial femoral neck fractures: possible reasons for delayed surgery. Part 2: Results of data from external inpatient quality assurance within the framework of secondary data evaluation].

Problem: In Germany a disproportionate number of patients with a femoral neck fracture still experience a delay in surgery. In 2008 delays of more than 48 h after admission occurred for 15.4 % of patients.

[Pertrochanteric fractures. What impact do surgical timing and implant choice have on the outcome?].

Pertrochanteric fractures are grouped together with femoral neck fractures to represent the most frequent femur fractures in the region of the hip joint and usually occur in elderly people with preexisting conditions. Analysis of the data from the 2004/2005 quality assurance program of North Rhine-Westphalia shows, just as is the case for medial femoral neck fractures, that not only does delayed management increase risk-adjusted general and surgical complications but also mortality.

[The influence of timing of surgery on mortality and early complications in femoral neck fractures, by surgical procedure: an analysis of 22,566 cases from the German External Quality Assurance Program].

Background: The current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated. PATIENTS UND METHODS: A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.

[Minimal provider volume in total knee replacement : an analysis of the external quality assurance program of North Rhine-Westphalia (QS-NRW)].

Background: A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of North Rhine-Westphalia (QS-NRW) were evaluated.

Method: A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications.

[Medial hip neck fracture: influence of pre-operative delay on the quality of outcome. Results of data from the external in-hospital quality assurance within the framework of secondary data analysis].

Problem: According to international and national studies and clinical guidelines, patients with medial hip neck fracture should receive surgery as soon as medically reasonable after hospitalization, preferably within 48 h. Analysis of the German quality registry data of 2006 showed, however, that in 13 out of the 16 federal states less than 85% of patients were operated on within 48. Delayed surgery was found especially during the weekend.

[Guideline compliance in hip fracture: results of an external quality-assurance program in North Rhine Westphalia: 2003-2005].

Background: Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance?

Materials And Methods: From North Rhine Westphalia, a total of 48,831 cases of femoral fractures near the hip joint were evaluated. Compliance with the guidelines was determined based on preoperative hospital stay, thrombosis, and antibiotic prophylaxis.

[Are there relevant minimum procedure volumes in trauma and orthopedic surgery?].

Introduction: The introduction of minimum surgical volumes aimed at improving the quality of care is currently the subject of controversial debate. One relevant issue is whether the data from external quality assurance can be used to predict outcomes that justify the introduction of minimum surgical volumes.

Method: Analysis was carried out on the procedures total knee replacements (arthroplasties) (TKA) and femoral neck fractures (FNF).

[Influence of operation time point on the frequency of early complications after surgical femoral neck fracture treatment].

Aim: The current publication deals with surgically treated medial and lateral femoral neck fracture of patients aged 60 and older.

Material/methods: All patients were evaluated who received operative treatment between day of trauma and day 14 after trauma. Therefore, 30,254 patients (77,44%) were included.