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Implementing, adapting, and validating an evidence-based algorithm for hip fracture surgery.

Ilija Ban1, Henrik Palm, Lasse Birkelund

  • 1*Department of Orthopaedics, Aabenraa Hospital, Aabenraa, Denmark; †Department of Orthopaedics, Hvidovre University Hospital, Hvidovre, Denmark; and ‡Department of Orthopaedics, Odense University Hospital, Odense, Denmark.

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Summary

Implementing a hip fracture surgical treatment algorithm showed a trend toward reduced reoperations. Higher adherence to the algorithm recommendations further decreased the reoperation rate in hip fracture patients.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Evidence-Based Medicine

Background:

  • Reoperations are a common complication following surgical treatment of hip fractures.
  • Optimal implant selection, guided by fracture classification, may reduce the need for reoperation.

Purpose of the Study:

  • To evaluate the feasibility of implementing an evidence-based surgical treatment algorithm for hip fractures.
  • To determine if this algorithm implementation leads to a reduced reoperation rate.

Main Methods:

  • A retrospective comparative study was conducted at a provincial level III trauma center.
  • An evidence-based hip fracture treatment algorithm was implemented in September 2008.
  • A total of 386 patients treated in the first year post-implementation were compared with 417 patients treated in the year prior.

Main Results:

  • Eighty-five percent of patients were operated according to the algorithm post-implementation, compared to 67% pre-implementation (P < 0.001).
  • The overall reoperation rate showed a tendency to decrease from 12% to 8% (P = 0.1).
  • Reoperation rates were significantly lower when procedures followed algorithm recommendations (9% vs. 14%, P = 0.009).

Conclusions:

  • The hip fracture surgery algorithm was easily implemented in a provincial setting.
  • Algorithm use facilitates a low reoperation rate, with potential for further reduction through increased adherence.