Are Process Changes Measurable? An Analysis of 4136 Proximal Femur Fractures over 16 Year

Area of Science:

• Traumatology
• Orthopedic Surgery
• Health Services Research

Background:

• Process changes in perioperative settings are rarely analyzed due to delayed outcomes and high data requirements.
• Proximal femur fractures (PF) represent a significant patient population where process optimization can impact care quality.

Purpose of the Study:

• To retrospectively evaluate process changes in the management of proximal femur fractures (PF).
• To assess the impact of these changes on specific outcome criteria.
• To define potential quality indicators for PF care.

Main Methods:

• Retrospective analysis of a Level 1 Trauma Center database for PF cases from 2006-2021.
• Categorization of 16 years into three periods, with 10 process changes implemented over the latter 10 years.
• Evaluation of changes based on operative revision rate, infection rate, perioperative transfusion rate, and 1-year mortality.

Main Results:

• Analysis of 4163 PF cases revealed that changes in the first 5 years (2012-2016), including intramedullary osteosynthesis and sterile drapes, most effectively reduced the operative revision rate below 10%.
• Subsequent process optimizations (2017-2021) led to measurable improvements in infection and transfusion rates.
• One-year mortality remained stable throughout the study period, including during the COVID-19 pandemic.

Conclusions:

• Process modifications in PF treatment do not yield immediate, objectively measurable improvements.
• The paradigm shift to intramedullary osteosynthesis appears to have had the most substantial impact, alongside gradual improvements in other criteria over the decade, excluding mortality.
• A 1-year revision rate below 10% should be pursued as an objective quality benchmark for PF care.