Saturday, February 16, 2002
Hip fracture treatment varies, more study needed to standardize care
Although general guidelines regarding the
treatment of patients with fractures of
the hip have been developed over the years,
it appears that treatment is quite variable across
the state of California. A study reported in poster
exhibit 385 suggests that treatment of hip
fractures requires more study in order to standardize the care
of patients and improve outcomes.
To find out how hip fracture patients
are really treated in the community,
a retrospective cohort study was performed on 1,001
elderly patients in a random sample from 60 California
hospitals. All patients were treated operatively for
a hip fracture in 1995-1996. The purpose
of the study was to identify the operative
treatment, perioperative management and mortality
of elderly patients with hip fractures.
A two-stage stratified random sample scheme was
used to generate the study population so that the
weighted numbers for the data presented
could be generalized to the entire hip
fracture population (less than 65 years old)
in California. Data was collected via a
meticulous chart review on a myriad of parameters
and mortality. A fair number of patients
received either inadequate or no deep vein
thrombosis (DVT) prophylaxis and some patients
did not receive perioperative antibiotics.
- The vast majority of fractures involved either the
femoral neck (52%)
or the intertrochanteric region (48%). Seventy-seven
percent of the patients were female.
- The vast majority of patients were treated with
either open reduction, internal fixation (60%) or
a hemiarthroplasty (48%). Fewer than 10% of
nondisplaced, versus 85% of displaced, femoral
neck fractures were treated with a hemiarthroplasty.
- The median time to surgery was 19 hours. However,
24% of patients had surgery less than 12 hours
after admission, 45% had it between 12 and 24
hours, 23% were operated on between 24 and 48
hours and 8% of patients
had surgery more than 48 hours after admission.
- Seventy-one patients were classified as ASA I, 210
as ASA II, 585 as ASA III and 136 as ASA IV.
- Seventy-six percent of patients received
antibiotics within four hours before surgical
incision. Seventy per-cent of patients
received appropriate DVT prophylaxis.
Pneumatic compression boots were
the most common form of prophylaxis.
- The in-hospital mortality rate was 4%.
The mortality rate at 6 months was 9%.
Co-authors of the study include Jay R. Lieberman, MD,
Los Angeles, Calif., and Patrick S. Romano, MD,
M. Chilcott-Lockwood, BS, Michael Schembri, BS, and H.
David Moehring, MD, all of Sacramento, Calif.
Last modified 16/February/2002