[Does hospital structure influence the outcome of operative treatment of femoral neck fractures?].
Data on 32 007 patients suffering from a medial fracture of the femoral neck have been collected between 1993 and 1999 in a database for external quality assurance organized by the chamber of physicians in Westfalia-Lippe. A statistical analysis (ANOVA, chi-square-test) has been performed to find out whether factors like specialization, annual volume or level of the hospital (primary, secondary or tertiary hospital) influence the outcome.


RESULTS
Patients with higher preoperative risk-factors are treated more often in primary hospitals. These clinics perform conservative treatment significantly more often than tertiary hospitals (6.5 % vs. 3.8 %). Osteosyntheses are performed more often in departments specialized in traumatology (13 %) or tertiary hospitals (16.8 %). Preoperative length of stay was 0.5-0.7 days shorter in these hospitals. There is no significant difference in postoperative complications all together (23.2-25.6 %), but a significantly lower rate in postoperative complications after osteosynthesis performed by departments specialized in traumatology (11.3 % vs. 18.8 %). A volume load of more than 50 cases per year correlates with a significant decline in postoperative complications (22.5 % vs. 28.2 %). Risk adjusted mortality does not show significant differences among the different levels of hospitals.


CONCLUSIONS
There are distinct differences regarding the way of treatment and procedural quality, but not concerning the short-term outcome between hospitals of different levels.
Smektala
R
R
Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik, Knappschaftskrankenhaus, Bochum, Germany. ruediger.smektala@ruhr-uni-bochum.de
Paech
S
S
Wenning
M
M
Hupe
K
K
Ekkernkamp
A
A
D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D013038:Specialization / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*
Bestimmt die Klinikstruktur die Qualität der chirurgischen Behandlung der Schenkelhalsfraktur? - Ergebnisse der externen Qualitätssicherung im Arztekammerbereich Westfalen-Lippe.