Biomaterial Database

A multicenter study on definitive surgery for isolated hip fracture within 24 hours. 2021

Darwin Ang, and Jeffrey Anglen, and Michele Ziglar, and John Armstrong, and Patrick Offner, and Mark McKenney, and David Plurad, and Stephen Flaherty, and Ernest Gonzalez, and Huazhi Liu, and Mary Danish, and Gregory McCormack, and Julie Nash, and Roger Nagy, and Matthew Carrick

From the Ocala Health Trauma, Ocala Regional Medical Center (D.A., H.L.), Ocala, Florida; Department of Surgery, University of South Florida (D.A., J. Armstrong), Tampa, Florida; University of Central Florida, College of Medicine (D.A.), Orlando, Florida; Division of Orthopedic Surgery, Mcleod Regional Medical Center (J. Anglen), Florence, South Carolina; Trauma Clinical Services Group, Hospital Corporation of America (M.Z., M.D., G.M., J.N.), Nashville, Tennessee; Department of Trauma, Sky Ridge Medical Center (P.O.), Lone Tree, Colorado; Department of Trauma, Kendall Regional Medical Center (M.M.), Miami, Florida; Department of Trauma, Riverside Community Hospital (D.P.), Riverside, California; Department of Trauma, Del Sol Medical Center (S.F.), El Paso, Texas; Department of Trauma, South Austin Medical Center (E.G.), Austin, Texas; Department of Trauma, TriStar Skyline Medical Center (R.N.), Nashville, Tennessee; and Department of Trauma, Medical City (M.C.), Plano, Texas.

Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes. This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05. Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively. Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality. Therapeutic/ Care management, Level III.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D005260	Female		Females
D006620	Hip Fractures	Fractures of the FEMUR HEAD; the FEMUR NECK; (FEMORAL NECK FRACTURES); the trochanters; or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region (FEMORAL FRACTURES).	Femoral Trochlear Fractures,Intertrochanteric Fractures,Subtrochanteric Fractures,Trochanteric Fractures,Trochlear Fractures, Femur,Femoral Trochlear Fracture,Femur Trochlear Fracture,Femur Trochlear Fractures,Fracture, Femoral Trochlear,Fracture, Femur Trochlear,Fractures, Femoral Trochlear,Fractures, Femur Trochlear,Fractures, Hip,Fractures, Intertrochanteric,Fractures, Subtrochanteric,Fractures, Trochanteric,Trochlear Fracture, Femoral,Trochlear Fracture, Femur,Trochlear Fractures, Femoral
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368	Aged	A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available.	Elderly
D000369	Aged, 80 and over	Persons 80 years of age and older.	Oldest Old
D013997	Time Factors	Elements of limited time intervals, contributing to particular results or situations.	Time Series,Factor, Time,Time Factor
D014193	Trauma Centers	Specialized hospital facilities which provide diagnostic and therapeutic services for trauma patients.	Trauma Units,Center, Trauma,Centers, Trauma,Trauma Center,Trauma Unit,Unit, Trauma,Units, Trauma
D016896	Treatment Outcome	Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.	Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes