The impact of current peri-operative care on outcomes for patients with hip fracture

Background: Fragility hip fractures among the elderly constitute a significant global public health problem. The disease is devastating for both patient and the family, often resulting in reduced mobility (disabling), increased reliance on others, diminished health and quality of life, and sometimes death. Thirty-day and one-year mortality rates are high. Postoperative morbidity and ‘delayed discharges’ are frequently cited with an average length of hospital stay of 19.5 days. Aim: This project aimed to assess impact of current perioperative care on patient outcome after hip fracture surgery. Methods: A systematic review was performed to identify currently available risk stratification tools used in hip fracture patients. The NHFS and SORT scoring tools were evaluated and recalibrated. A mixed methods study to identify public (patients, relatives and healthcare professionals) perceptions on factors delaying discharge was conducted and a cohort follow up study of 341 patients to develop and validate a Hip Fracture postoperative morbidity survey tool (HF-POMS). Results and conclusion: The NHFS and SORT performed better than other risk stratification tools in the literature; however, they both needed further validation. Five key factors of importance identified by the public affecting LOS were; medical conditions (both prefracture comorbidities and postoperative complications), age and frailty, the recovery process (mobility and rehabilitation) psychological aspects and social factors. A 12- domains validity tool (HF-POMS) was developed with kappa interrater reliability of 0.68. High morbidity presence was seen in the following domains; renal, assisted ambulation, pain and infectious. Presence of any morbidity on postoperative days 8 and 15 was associated with subsequent LOS of 3.08 days (95% CI 0.90 – 5.26, p= 0.005) and 15.81 days (95% CI 13.35 – 18.27, p = 0.001) respectively. The average LOS was 16.9 days. The HF–POMS is a reliable and valid tool for measuring immediate postoperative complications in hip fracture patients. Many patients remained in hospital for non-medical reasons