| 1. |
- Hommel, Ami, et al.
(författare)
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Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year
- 2008
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 39:10, s. 1164-1174
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Tidskriftsartikel (refereegranskat)abstract
- Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).
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| 2. |
- Hommel, Ami, et al.
(författare)
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Differences in complications and length of stay between patients with a hip fracture treated in an orthopaedic department and patients treated in other hospital departments
- 2008
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Ingår i: Journal of Orthopaedic Nursing. - : Elsevier. - 1361-3111 .- 1873-4839 .- 1878-1292. ; 12:1, s. 13-25
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Tidskriftsartikel (refereegranskat)abstract
- The health care system has to deal with substantial health care costs, which are expected to continue to rise due to increasingly elderly populations. One way of saving has been a reduction of the number of beds in hospitals. The consequence is that acute patients are inappropriately admitted to non-specialized wards because of limited beds. These patients are also known as “outliers”. In this study, consecutive patients with a hip fracture treated at the orthopaedic department (n = 273) are compared with patients treated at other departments (n = 147) according to the incidence of complications and the length of stay (LOS) before and after the introduction of an evidence-based clinical pathway. There was no medical difference between the populations. However, the strict demands of saving costs, with limited beds, have resulted not only in economic consequences with prolonged hospitalization, but also in patient suffering and the inconvenience of increased postoperative complications.Patients treated at non-specialized wards had an extra LOS of 3.7 days in the acute hospital settings and furthermore, 13.6 days of LOS including rehabilitation compared to patients treated at the orthopaedic department. In addition, we consider the implemented evidence-based clinical pathway to be successful since the number of complications was reduced. It is a major challenge to establish effective treatment and rehabilitation for patients after a hip fracture aiming to avoid complications and reduce LOS. These fragile patients with a hip fracture ought to be treated at the orthopaedic department, or at departments with geriatric and rehabilitation knowledge. Physiotherapists, occupational therapists and nurses specialising in orthopaedics and geriatricians should take an active part in the care of these patients.
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