IntroductionThe objectives of the study were to: 1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty (HA) and surgical recommendations for treatment of displaced intra-capsular hip fractures; 2) describe why THA is performed when NICE criteria are not met; and 3) determine whether satisfaction with these guidelines is associated with improved outcomes.MethodsA retrospective chart review of patients who had a displaced intra-capsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Pre-operative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, peri-operative complications, re-operation, and revision arthroplasty within 12 months of surgery were recorded.ResultsData from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The two most common reasons for performing a THA when NICE criteria were not met (n = 35) included pre-operative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer peri-operative complications (0.6 versus 37.1%; P < 0.001), re-operations (0.6 versus 31.4%; P < 0.001), and revisions (0.6 versus 28.6%; P < 0.001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%).DiscussionSatisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if pre-existing hip osteoarthritis and younger age merit consideration in patient selection. 

National Institute of Health and Care Excellence (NICE) Guidelines for Displaced Intracapsular Hip Fractures: Examining Satisfaction with the Guidelines and Effects on Outcomes.

Introduction Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (&gt;6 days post-surgery). Results A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR .50, 95% CI .32;.79) compared to a weekday, patients had a total hip replacement (OR .28, 95% CI .10;.80) or dynamic hip screw fixation (OR .49, 95% CI .25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR .05, 95% CI .02;.13), home (OR .26, 95% CI .15;.46), or transferred to another specialty in the hospital (OR .49, 95% CI .29;.84) compared to inpatient rehabilitation. Conclusions Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care. 

Barriers to Discharge of Hip Fracture Patients From An Academic Hospital: A Retrospective Data Analysis

Background: Current national guidelines on caring for hip fractures recommend early mobilization. However, this recommendation does not account for time spent immobilized waiting for surgery. We sought to determine timing of mobilization following hip fracture, beginning at hospital admission, and evaluate its association with medical complications and length of hospital stay (LOS). Methods: We performed a retrospective review of prospectively collected data for 470 consecutive patients who underwent surgery for a hip fracture between September 2019 and August 2020 at an academic, tertiary-referral hospital. Outcomes of interest included time from hospital admission to mobilization, complication rate and LOS. We used a binary regression analysis to determine the effect of different surgical and patient factors on the risk of a postoperative medical complication. Results: The mean time from admission to mobilization was 2.8 ± 2.3 days (range 3 h–14 d). There were 125 (26.6%) patients who experienced at least 1 complication. The odds of developing a complication began to increase steadily once a patient waited more than 3 days from admission to mobilization (odds ratio 2.15, 95% confidence interval 1.42–3.25). Multivariate regression analysis showed that prefracture frailty (β = 0.276, p = 0.05), and timing from hospital admission to mobilization (β = 0.156, p < 0.001) and from surgery to mobilization (β = 1.195, p < 0.001) were associated with complications. The mean LOS was 12.2 ± 10.7 days (range 1–90 d). Prolonged wait to mobilization was associated with longer LOS (p = 0.01). Conclusion: Comprehensive guidelines on timing of mobilization following hip fracture should account for cumulative time spent immobilized.

https://www.canjsurg.ca/content/cjs/66/4/E432.full.pdf

Delayed mobilization following admission for hip fracture is associated with increased morbidity and length of hospital stay.

Delayed Mobilization Following Hip Fracture Surgery is Associated with Increased Morbidity and Length of Hospital Stay

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Delayed mobilization following admission for hip fracture is associated with increased morbidity and length of hospital stay.

Delayed Mobilization Following Hip Fracture Surgery is Associated with Increased Morbidity and Length of Hospital Stay