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Geriatric medicine
Research
Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care
  1. Kristin Haugan1,
  2. Lars G Johnsen1,2,
  3. Trude Basso1,
  4. Olav A Foss1
  1. 1 Department of Orthopaedics, Orthopaedic Research Centre, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  2. 2 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
  1. Correspondence to Kristin Haugan; kristin.haugan{at}ntnu.no

Abstract

Objective To compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.

Design Retrospective single-centre study.

Setting University hospital in middle Norway.

Participants 1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).

Interventions 788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013.

Primary and secondary outcome Primary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay.

Results We found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways.

Conclusions There was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased.

Trial registration number NCT00667914; results

  • hip fracture
  • fast track
  • comorbidity
  • length of stay
  • pathway
  • medication reconciliation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015574

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    Footnotes

    • Contributors OAF planned the study, wrote the statistical analysis plan, did the data analysis, made the tables and figures and revised the manuscript. TB planned the study and revised the manuscript. LGJ planned the study and revised the manuscript. KH planned the study, did the data collection and the data analysis, wrote and revised the manuscript.

    • Competing interests None declared.

    • Ethics approval Regional Committee for Medical Research Ethics, Central Norway.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.