The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data.

Med Care

*Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine †Clinical Effectiveness Unit, The Royal College of Surgeons of England ‡Formerly of Geriatric Medicine Unit, School of Clinical Sciences and Community Health, College of Medicine and Veterinary Medicine, Edinburgh University, Royal Infirmary of Edinburgh §Basildon & Thurrock University Hospitals NHS Foundation Trust ∥Royal National Orthopaedic Hospital NHS Trust ¶Department of Medical Statistics, London School of Hygiene & Tropical Medicine.

Published: August 2015

Background: Hip fracture is the most common serious injury of older people. The UK National Hip Fracture Database (NHFD) was launched in 2007 as a national collaborative, clinician-led audit initiative to improve the quality of hip fracture care, but has not yet been externally evaluated.

Methods: We used routinely collected data on 471,590 older people (aged 60 years and older) admitted with a hip fracture to National Health Service (NHS) hospitals in England between 2003 and 2011. The main variables of interest were the use of early surgery (on day of admission, or day after) and mortality at 30 days from admission. We compared time trends in the periods 2003-2007 and 2007-2011 (before and after the launch of the NHFD), using Poisson regression models to adjust for demographic changes.

Findings: The number of hospitals participating in the NHFD increased from 11 in 2007 to 175 in 2011. From 2007 to 2011, the rate of early surgery increased from 54.5% to 71.3%, whereas the rate had remained stable over the period 2003-2007. Thirty-day mortality fell from 10.9% to 8.5%, compared with a small reduction from 11.5% to 10.9% previously. The annual relative reduction in adjusted 30-day mortality was 1.8% per year in the period 2003-2007, compared with 7.6% per year over 2007-2011 (P<0.001 for the difference).

Interpretation: The launch of a national clinician-led audit initiative was associated with substantial improvements in care and survival of older people with hip fracture in England.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501693PMC
http://dx.doi.org/10.1097/MLR.0000000000000383DOI Listing

Publication Analysis

Top Keywords

hip fracture
20
clinician-led audit
8
audit initiative
8
time trends
8
older people
8
early surgery
8
period 2003-2007
8
hip
5
fracture
5
impact national
4

Similar Publications

Prevalence of vertebral fractures at death.

J Bone Miner Metab

January 2025

Department of Internal Medicine 1, Shimane University Faculty of Medicine, Shimane, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.

Introduction: Despite many studies on the prevalence of vertebral fractures (VFs), the VF prevalence at death in the Japanese population remains unclear.

Materials And Methods: We evaluated the VF prevalence at death in a Japanese cohort using autopsy imaging computed tomography (AiCT). We enrolled 365 cadavers (188 men, 177 women, mean age of 84.

View Article and Find Full Text PDF

Background: The number of patients with hip and femoral fractures is increasing and is expected to further increase in upcoming years due to the ageing population and the life expectancy of the general population. In this analysis, we aimed to systematically assess the post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture.

Methods: Common online databases: Google Scholar, Web of Science, MEDLINE, Cochrane database, EMBASE ( www.

View Article and Find Full Text PDF

As surgeons, we strive to recognize and correct any mistakes that may occur before completing an operation, and importantly, do our best to avoid irreversible mistakes. Over-resection of the femoral cam lesion in patients having hip arthroscopy for femoroacetabular impingement syndrome has been considered irreversible. While cam under-resection is a technical complication of femoroacetabular impingement surgery to be avoided, avoiding this at the expense of over-resection of the proximal femur is of great concern.

View Article and Find Full Text PDF

Use of Cemented Hemiarthroplasty for Femoral Neck Fractures.

J Am Acad Orthop Surg Glob Res Rev

January 2025

From the Department of Orthopaedics, University of Missouri-Kansas City, Kansas City, MO (Dr. Amin, Dr. Krumme, Dr. Gause, Dr. Dubin, and Dr. Cil), and the Department of Orthopaedics, Kansas City Orthopaedic Alliance, Leawood, KS (Dr. Krumme).

Geriatric femoral neck fractures are common orthopaedic injuries, which are associated with a high morbidity and mortality. Arthroplasty is the optimum treatment for many of these injuries, but debate exists regarding optimal surgical strategy. Multiple recent investigations have demonstrated strong superiority for cemented stems as compared with noncemented fixation with a decreased risk of periprosthetic fracture, shorter length of stay, lower cost, and decreased rate for revision surgery.

View Article and Find Full Text PDF

Direct anterior and direct lateral approach in patients with femoral neck fractures receiving a total hip arthroplasty: a randomized controlled trial.

Acta Orthop

January 2025

Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund; Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.

Background And Purpose:  The optimal approach to the hip joint in patients with displaced femoral neck fractures (dFNF) receiving a total hip arthroplasty (THA) remains controversial. We compared the direct lateral approach (DLA) with the direct anterior approach (DAA) primarily on Timed Up and Go (TUG), and secondarily on the Forgotten Joint Score (FJS), the Oxford Hip Score (OHS), EQ5D-5L, and the EQ5D-VAS.

Methods:  Between 2018 and 2023, we conducted a randomized controlled trial including elderly patients with dFNFs treated with THA.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!