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A multicenter study on definitive surgery for isolated hip fracture within 24 hours
Darwin Ang1, Jeffrey Anglen, Michele Ziglar
1From the Ocala Health Trauma, Ocala Regional Medical Center (D.A., H.L.), Ocala, Florida; Department of Surgery, University of South Florida (D.A., J. Armstrong), Tampa, Florida; University of Central Florida, College of Medicine (D.A.), Orlando, Florida; Division of Orthopedic Surgery, Mcleod Regional Medical Center (J. Anglen), Florence, South Carolina; Trauma Clinical Services Group, Hospital Corporation of America (M.Z., M.D., G.M., J.N.), Nashville, Tennessee; Department of Trauma, Sky Ridge Medical Center (P.O.), Lone Tree, Colorado; Department of Trauma, Kendall Regional Medical Center (M.M.), Miami, Florida; Department of Trauma, Riverside Community Hospital (D.P.), Riverside, California; Department of Trauma, Del Sol Medical Center (S.F.), El Paso, Texas; Department of Trauma, South Austin Medical Center (E.G.), Austin, Texas; Department of Trauma, TriStar Skyline Medical Center (R.N.), Nashville, Tennessee; and Department of Trauma, Medical City (M.C.), Plano, Texas.
Implementing an Isolated Hip Fracture Process Management Guideline (IHF-PMG) significantly reduced inpatient mortality in elderly patients. This guideline expedited definitive surgery within 24 hours, improving patient outcomes across a large hospital network.
Area of Science:
- Geriatric Trauma Surgery
- Healthcare Process Improvement
- Patient Outcome Research
Background:
- Isolated hip fractures (IHFs) in the elderly are common and significantly impact patient health.
- Timely surgical intervention (≤24 hours) is crucial for better outcomes in IHF patients.
- A standardized process management guideline (IHF-PMG) was developed to improve surgical timing.
Purpose of the Study:
- To assess the feasibility of implementing an IHF-PMG across a multihospital network.
- To evaluate the impact of the IHF-PMG on patient outcomes, specifically inpatient mortality.
- To compare outcomes between hospitals with and without the implemented guideline.
Main Methods:
- A prospective multicenter cohort study involving 85 trauma centers.
- Four patient cohorts were analyzed based on guideline implementation: none, self-developed, partial network, and full network IHF-PMG.
- Multivariable logistic regression with reliability adjustment was used to analyze observed to expected (O/E) mortality ratios.
Main Results:
- The overall IHF O/E mortality ratio within the network decreased from 1.13 in 2017 to 0.86 in 2019 post-guideline implementation.
- Hospitals fully implementing their own or the network's IHF-PMG showed the lowest inpatient O/E mortality rates (0.59 and 0.65, respectively).
- The IHF-PMG demonstrated feasibility and a positive association with reduced inpatient mortality.
Conclusions:
- A goal-directed IHF-PMG effectively expedited definitive surgery within 24 hours across a large hospital network.
- The implementation of the IHF-PMG was associated with a significant reduction in inpatient mortality for elderly patients with isolated hip fractures.
- Standardized process management guidelines are effective in improving care and outcomes for high-risk surgical populations.
