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A standardized clinical pathway for hip fracture patients is associated with reduced mortality: data from the
Tuva Elisabeth Garre-Fivelsdal1, Jan-Erik Gjertsen2,3, Eva Dybvik4
1University of Bergen, Bergen, Norway.
Purpose:
A standardized clinical pathway is recommended for hip fracture patients. We aimed to survey standardization of treatment in Norwegian hospitals and to investigate whether this affected 30-day mortality and quality of life after hip fracture surgery.
Methods:
Based on the national guidelines for interdisciplinary treatment of hip fractures, nine criteria for a standardized clinical pathway were identified. A questionnaire was sent to all Norwegian hospitals treating hip fractures in 2020 to survey compliance with these criteria. A standardized clinical pathway was defined as a minimum of eight criteria fulfilled. Thirty-day mortality for patients treated in hospitals with and without a standardized clinical pathway was compared using data in the Norwegian Hip Fracture Register (NHFR).
Results:
29 out of 43 hospitals (67%) answered the questionnaire. Of these, 20 hospitals (69%) had a standardized clinical pathway. Compared to these hospitals, there was a significantly higher 30-day mortality in hospitals without a standardized clinical pathway in the period 2016-2020 (HR 1.13, 95% CI 1.04-1.23; p = 0.005). 4 months postoperatively, patients treated in hospitals with a standardized clinical pathway and patients treated in hospitals without a standardized clinical pathway reported an EQ-5D index score of 0.58 and 0.57 respectively (p = 0.038). Significantly more patients treated in hospitals with a standardized clinical pathway were 4 months postoperatively able to perform usual activities (29% vs 27%) and self-care (55% vs 52%) compared to hospitals without a standardized clinical pathway.
Conclusion:
A standardized clinical pathway for hip fracture patients was associated with reduced 30-day mortality, but no clinically important difference in quality of life compared to a non-standardized clinical pathway.
