Inter-departmental variation in surgical treatment of proximal femoral fractures : A nationwide observational cohort study
(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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- author
- Hernefalk, Björn ; Rydberg, Emilia Möller ; Ekelund, Jan ; Rogmark, Cecilia LU ; Möller, Michael LU ; Hailer, Nils P. ; Mukka, Sebastian and Wolf, Olof
- organization
- publishing date
- 2023-02
- 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}}, }