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The impact of care process development and comorbidity on time to surgery, mortality rate and functional outcome for hip fracture patients : A retrospective analysis over 19 years with data from the Swedish National Registry for hip fracture patients, RIKSHÖFT

Turesson, Emma LU ; Ivarsson, Kjell LU ; Thorngren, Karl Göran LU and Hommel, Ami LU (2019) In BMC Musculoskeletal Disorders 20(1).
Abstract

For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type. Methods: Patients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient... (More)

For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type. Methods: Patients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient characteristics, fracture type, operation method, lead-times and outcome were analyzed. For comparison Fischer's exact test and Spearman's rank correlation coefficient was used for the categorical data and Pearson correlation coefficient for the continuous. To further analyze the effect over time a linear regression model was used. Results: A total of 7827 patients were included. A significant shift in the overall morbidity was seen, with an increase in patients of higher ASA grade. No correlation was seen between outcome and the care process development. The mortality rate for the group as a whole the mortality rate had decreased over time. The total length of stay had decreased significantly over time. There was no statistically significant change in mortality rate over time when relating it to time-to-surgery. Conclusions: Although the patients display a higher morbidity over time, the mortality rate has not changed significantly, which might indicate an effect of the care process development. The care process development does not seem to impact on outcome as much as other factors. This study supports the possibility to create a more specific algorithm for hip fracture patients, taking specific subgroups into consideration.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Care process development, Hip fracture, Outcome, Timing to surgery
in
BMC Musculoskeletal Disorders
volume
20
issue
1
article number
616
publisher
BioMed Central (BMC)
external identifiers
  • pmid:31878903
  • scopus:85077183048
ISSN
1471-2474
DOI
10.1186/s12891-019-3007-0
language
English
LU publication?
yes
id
0840b0d5-c117-4c7b-9c03-ff9f38b81197
date added to LUP
2020-01-10 12:33:06
date last changed
2020-07-08 05:10:36
@article{0840b0d5-c117-4c7b-9c03-ff9f38b81197,
  abstract     = {<p>For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type. Methods: Patients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient characteristics, fracture type, operation method, lead-times and outcome were analyzed. For comparison Fischer's exact test and Spearman's rank correlation coefficient was used for the categorical data and Pearson correlation coefficient for the continuous. To further analyze the effect over time a linear regression model was used. Results: A total of 7827 patients were included. A significant shift in the overall morbidity was seen, with an increase in patients of higher ASA grade. No correlation was seen between outcome and the care process development. The mortality rate for the group as a whole the mortality rate had decreased over time. The total length of stay had decreased significantly over time. There was no statistically significant change in mortality rate over time when relating it to time-to-surgery. Conclusions: Although the patients display a higher morbidity over time, the mortality rate has not changed significantly, which might indicate an effect of the care process development. The care process development does not seem to impact on outcome as much as other factors. This study supports the possibility to create a more specific algorithm for hip fracture patients, taking specific subgroups into consideration.</p>},
  author       = {Turesson, Emma and Ivarsson, Kjell and Thorngren, Karl Göran and Hommel, Ami},
  issn         = {1471-2474},
  language     = {eng},
  month        = {12},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Musculoskeletal Disorders},
  title        = {The impact of care process development and comorbidity on time to surgery, mortality rate and functional outcome for hip fracture patients : A retrospective analysis over 19 years with data from the Swedish National Registry for hip fracture patients, RIKSHÖFT},
  url          = {http://dx.doi.org/10.1186/s12891-019-3007-0},
  doi          = {10.1186/s12891-019-3007-0},
  volume       = {20},
  year         = {2019},
}