The treatment of hip fractures: variations in care.
The purpose of this descriptive study was to identify the ranges of operative treatment, perioperative management, and mortality rate of elderly patients with hip fractures. We retrospectively identified 1001 elderly patients who had operative treatment for a fractured hip in 49 medium- and high-volume California hospitals using a two-stage stratified cluster sample of hospitalizations for hip fractures. This sampling method allowed for generation of weighted estimates that described the overall care of all patients with hip fractures in California from 1995 to 1996. The in-hospital, 30-day, and 6-month mortality rates were 1.7%, 5%, and 12% respectively. Bipolar hemiarthroplasties were used more often than unipolar implants (73% versus 26%). There were some deviations from generally accepted guidelines for care of patients with hip fractures particularly related to administration of antibiotic and deep vein thrombosis prophylaxis. Fourteen percent of patients did not receive any antibiotic prophylaxis before and during surgery, and 24% did not receive prophylaxis within 4 hours of the beginning of the surgical procedure. Twenty-four percent of patients received no prophylaxis for deep vein thrombosis, and 81% of patients did not receive prophylaxis after hospital discharge. Surgeons need to continually evaluate the treatment regimens for patients with hip fractures to optimize care.


METHODS
Descriptive Study, Level II (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
Lieberman
Jay R
JR
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. jlieberman@mednet.ucla.edu
Romano
Patrick S
PS
Mahendra
Geeta
G
Keyzer
Janet
J
Chilcott
Marisha
M
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012494:Sampling Studies; D020246:Venous Thrombosis / Q000517:prevention & control