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Inter-departmental variation in surgical treatment of proximal femoral fractures : A nationwide observational cohort study

Hernefalk, Björn ; Rydberg, Emilia Möller ; Ekelund, Jan ; Rogmark, Cecilia LU ; Möller, Michael LU ; Hailer, Nils P. ; Mukka, Sebastian and Wolf, Olof (2023) In PLoS ONE 18(2 February).
Abstract

Background and purpose Hip fractures should be treated based on the best available evidence and cost-effectively to optimize the outcome for this large group of frail patients. This study examined nationwide variation in surgical methods used for hip fractures. Methods In this cohort study 46,243 patients ≥65 years with a trochanteric hip fracture (THF) or a femoral neck fracture (FNF) registered in the Swedish Fracture Register (SFR) between 1 January 2016 and 31 December 2020 were included. Fractures were classified according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The choice of surgical methods was assessed for each fracture type to compare national variation. Results 21,312 THFs... (More)

Background and purpose Hip fractures should be treated based on the best available evidence and cost-effectively to optimize the outcome for this large group of frail patients. This study examined nationwide variation in surgical methods used for hip fractures. Methods In this cohort study 46,243 patients ≥65 years with a trochanteric hip fracture (THF) or a femoral neck fracture (FNF) registered in the Swedish Fracture Register (SFR) between 1 January 2016 and 31 December 2020 were included. Fractures were classified according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The choice of surgical methods was assessed for each fracture type to compare national variation. Results 21,312 THFs and 24,072 FNFs (67% women) with a mean age of 83 years (SD 8) were surgically treated. In the treatment of two-fragment THFs (AO/OTA A1) departments ranged from using 90% short intramedullary nails to 98% sliding hip screws. Treating displaced FNFs (AO/OTA B3), the proportion of hemiarthroplasty ranged from 9 to 90%, and internal fixation between 0.6 to 21%, depending on the department. Interpretation A mature national fracture register permits the monitoring of treatment provided and thus serves as an important aid in assessing compliance with guidelines. The large interdepartmental variation in the surgical management of hip fractures in Sweden appears unwarranted based on the current evidence, indicating a need for updated national guidelines. Further research will have to clarify the impact of this variation on mortality and re-operation rates.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
18
issue
2 February
article number
e0281592
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:85147834375
  • pmid:36757969
ISSN
1932-6203
DOI
10.1371/journal.pone.0281592
language
English
LU publication?
yes
id
8fa42e23-596d-44c2-8962-fe98dca16155
date added to LUP
2023-02-21 12:27:51
date last changed
2024-04-18 12:06:04
@article{8fa42e23-596d-44c2-8962-fe98dca16155,
  abstract     = {{<p>Background and purpose Hip fractures should be treated based on the best available evidence and cost-effectively to optimize the outcome for this large group of frail patients. This study examined nationwide variation in surgical methods used for hip fractures. Methods In this cohort study 46,243 patients ≥65 years with a trochanteric hip fracture (THF) or a femoral neck fracture (FNF) registered in the Swedish Fracture Register (SFR) between 1 January 2016 and 31 December 2020 were included. Fractures were classified according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The choice of surgical methods was assessed for each fracture type to compare national variation. Results 21,312 THFs and 24,072 FNFs (67% women) with a mean age of 83 years (SD 8) were surgically treated. In the treatment of two-fragment THFs (AO/OTA A1) departments ranged from using 90% short intramedullary nails to 98% sliding hip screws. Treating displaced FNFs (AO/OTA B3), the proportion of hemiarthroplasty ranged from 9 to 90%, and internal fixation between 0.6 to 21%, depending on the department. Interpretation A mature national fracture register permits the monitoring of treatment provided and thus serves as an important aid in assessing compliance with guidelines. The large interdepartmental variation in the surgical management of hip fractures in Sweden appears unwarranted based on the current evidence, indicating a need for updated national guidelines. Further research will have to clarify the impact of this variation on mortality and re-operation rates.</p>}},
  author       = {{Hernefalk, Björn and Rydberg, Emilia Möller and Ekelund, Jan and Rogmark, Cecilia and Möller, Michael and Hailer, Nils P. and Mukka, Sebastian and Wolf, Olof}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{2 February}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Inter-departmental variation in surgical treatment of proximal femoral fractures : A nationwide observational cohort study}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0281592}},
  doi          = {{10.1371/journal.pone.0281592}},
  volume       = {{18}},
  year         = {{2023}},
}