[Factors affecting quality of care for elderly subjects undergoing surgery for hip fracture: review of the literature].
Hip fractures are one of the leading causes for admission of elderly subjects to healthcare facilities. Because of population aging, the incidence of hip fractures has increased considerably over the last years and will continue to increase in industrialized countries. Hip fracture in an elderly subject may be life threatening and has a significant functional and social impact not only because of the fracture itself, but also because of the risk of complications related to the patient's health status and the long hospital stay. The purpose of this work was to identify in the published literature professional practices, excepting the surgical procedure, associated with better early and long-term outcome in elderly patients with hip fracture. Questions raised concerning the patient's hospital stay include factors related to the preoperative phase (time to surgery, usefulness of traction), the operation itself (antibiotic prophylaxis, anesthesia technique), and the postoperative phase (prevention of venous thrombosis, malnutrition, episodes of confusion, duration of indwelling bladder catheter, correction of anemia, geriatric care during the stay in the orthopedic ward, early and intense rehabilitation, prevention of recurrence). Among these factors, several appear to be associated with better outcome, including long-term outcome--surgery as early as possible in light of the patient's general status, antibiotic prophylaxis in accordance with standard recommendations (SFAR), prevention of venous thrombosis with low-molecular-weight heparin initiated at admission and associated with elastic contention. Oral nutritional support is probably beneficial and should be proposed for all patients. Particular attention must be given to prevention of confusion in order to reduce the rate of institutionalization. The rythm of rehabilitation exercises should be at least five sessions per week. Finally, there are several methods, which are effective in preventing recurrence, taking into account osteoporosis, risk of falls. Preventive measures should be instituted for all patients undergoing surgery for hip fracture.
Merle
V
V
Département d'Epidémiologie et de Santé Publique, CHU de Rouen, Hôpitaux de Rouen, 1, rue de Germont, 76031 Rouen Cedex.
Moret
L
L
Josset
V
V
Pidhorz
L
L
Piétu
G
G
Gouin
F
F
Riou
F
F
Chassagne
P
P
Petit
J
J
Lombrail
P
P
Czernichow
P
P
Dujardin
F
F
D000368:Aged; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011787:Quality of Health Care