Decreasing mortality for patients undergoing hip fracture repair surgery

Staten Island University Hospital (Staten Island, New York) undertook an initiative to reduce mortality in a high-risk population on the basis of findings from a root cause analysis (RCA).

A 78-year-old woman admitted following a fall was diagnosed with a femur fracture. The medical history was significant for chronic obstructive pulmonary disease, hypothyroidism, and laryngeal cancer. A medical consultant classified the patient as grade II (American Society of Anaesthesiologists-Physical Status [ASA] scale), no contra-indication for operating room (OR). An anesthesiologist evaluated the patient as an ASA grade III/IV. The patient went to the OR and died after anesthesia induction. The RCA revealed inadequate communication between providers and preoperative assessment and no framework to privilege providers for high risk preoperative evaluations. Proposed corrective actions included use of a preoperative assessment tool.

During the baseline year, 2000, the preimplementation mortality rate for 185 patients undergoing hip fracture repair surgery was 4.9%. For the 644 postimplementation patients, the mortality rate decreased to 2.7% for both 2001 and 2002 and to 1% for 2003. Comparison of the 2000 baseline and 2003 mortalities indicated a statistically significant mortality reduction of 79% (p = .0245).

Mortality rates can be reduced by systematic application of comprehensive preoperative assessment when implemented by specially trained and privileged staff.