Objectives: Assess feasibility of a cluster randomised controlled trial (RCT) to measure clinical and cost-effectiveness of an enhanced recovery pathway for people with hip fracture and cognitive impairment (CI).
Design: Feasibility trial undertaken between 2016 and 2018.
Setting: Eleven acute hospitals from three UK regions.
Participants: 284 participants (208 female:69 male).
Inclusion Criteria: aged >60 years, confirmed proximal hip fracture requiring surgical fixation and CI; preoperative AMTS ≤8 in England or a 4AT score ≥1 in Scotland; minimum of 5 days on study ward; a 'suitable informant' able to provide proxy measures, recruited within 7 days of hip fracture surgery.
Exclusion Criteria: no hip surgery; not expected to survive beyond 4 weeks; already enrolled in a clinical trial.
Intervention: PERFECT-ER, an enhanced recovery pathway with 15 quality targets supported by a checklist and manual, a service improvement lead a process lead and implemented using a plan-do-study-act model.
Primary And Secondary Outcome Measures: Feasibility outcomes: recruitment and attrition, intervention acceptability, completion of participant reported outcome measures, preliminary estimates of potential effectiveness using mortality, EQ-5D-5L, economic and clinical outcome scores.
Results: 282 participants were consented and recruited (132, intervention) from a target of 400. Mean recruitment rates were the same in intervention and control sites, (range: 1.2 and 2.7 participants/month). Retention was 230 (86%) at 1 month and 54%(144) at 6 months. At 3 months a relatively small effect (one quarter of an SD) was observed on health-related quality of life of the patient measured with EQ-5D-5L proxy in the intervention group.
Conclusion: This trial design was feasible with modifications to recruitment. Mechanisms for delivering consistency in the PERFECT-ER intervention and participant retention need to be addressed. However, an RCT may be a suboptimal research design to evaluate this intervention due to the complexity of caring for people with CI after hip fracture.
Trial Registration Number: ISRCTN99336264.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886407 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2021-055267 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Comparative analysis of general and regional anesthesia applications in geriatric hip fracture surgery.
Medicine (Baltimore)
January 2025
Department of Anesthesiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China.
Background: This study compares the outcomes of general anesthesia (GA) and regional anesthesia (RA) in geriatric hip fracture surgery to determine optimal anesthesia strategies for this population.
Methods: A comprehensive literature review was conducted, analyzing studies comparing GA and RA in elderly patients undergoing hip fracture surgery. Studies encompassed various designs, including randomized controlled trials, cohort studies, and meta-analyses.
Association between preoperative serum albumin levels and length of stay in elderly patients with hip fractures: A nonlinear relationship.
Medicine (Baltimore)
January 2025
Teaching Office, Second People's Hospital of Shenzhen (First Affiliated Hospital of Shenzhen University), Shenzhen City, China.
Previous studies have provided relatively limited evidence in examining the impact of preoperative serum albumin levels on the length of hospital stay (LOS) in patients with hip fractures. This study aimed to elucidate the association between preoperative serum albumin levels and LOS in elderly patients with hip fractures. This retrospective cohort study included 1444 elderly patients undergoing surgical treatment for hip fractures at the Second People's Hospital of Shenzhen from January 2012 to December 2021.
View Article and Find Full Text PDFHigh Rate of Complications With Early Conversion Hip Arthroplasty Following Fracture Treatment.
J Am Acad Orthop Surg Glob Res Rev
November 2024
From the Department of Orthopaedic Surgery and Rehabilitation Loyola University Health System, Maywood, IL (Dr. Grayson, Dr. Eikani, and Dr. Brown); and the Loyola University Chicago Stritch School of Medicine, Maywood, IL (Ms. Benson and Mr. Jozefowski).
Background: Conversion total hip arthroplasty (THA) is associated with higher rates of complications compared with primary THA, with prior surgical fixation of fractures in the ipsilateral hip shown to further increase these rates. There is a scarcity of literature on the effect of timing of conversion THA on complication rates. In this study, we evaluated early (≤6 months of index surgery) and late (>6 months of index surgery) conversion to THA following prior fixation of the proximal femur or acetabulum.
View Article and Find Full Text PDFSpinal Anesthesia in Elderly Patients With Femoral Neck Fractures on Apixaban Therapy: A Case Series.
A A Pract
January 2025
From the Department of Anesthesiology, Sheba Medical Center, Ramat Gan, Israel.
This case series reviews surgeries involving elderly patients with femoral neck fractures on apixaban who underwent spinal anesthesia (SA) within 72 hours of their last dose. Despite patients being on anticoagulation, no neurological complications occurred, suggesting SA may be practical in cases where the benefits of timely surgery outweigh the potential risks, including apixaban discontinuation for a period of less than the recommended 72 hours with detectable levels of the drug remaining in the plasma. Quantitative apixaban measurements offered useful anticoagulation status insights, though safe thresholds remain undefined.
View Article and Find Full Text PDFIntramedullary Nail Failure in a Subtrochanteric Fracture in a 62-Year-Old Woman.
Cureus
December 2024
Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Subtrochanteric fractures in older patients are typically due to low-energy falls. The standard of care is intramedullary nailing. The Smith & Nephew Trigen Intertan (Memphis, TN, US) is an intramedullary nail with a novel design that incorporates two integrated compression screws.
View Article and Find Full Text PDFWant 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!