Prospective study of surgical delay for hip fractures: impact of an orthogeriatrician and increased trauma capacity.
Most health services in the United Kingdom provide unacceptable in-hospital care for hip fracture patients. We describe the impact on surgical delay following the introduction of an orthogeriatrician and the addition of one extra trauma list per week at our centre. Prospective data were collected on 101 consecutive patients followed by a second cohort of 105 patients. Mean time to surgery in cohorts 1 and 2 was 4.08 and 4.05 days, respectively (p = 0.71). Diagnosis of medical comorbidity increased with input from the orthogeriatrician from 69.7% to 74.2% (p = 0.24). Length of stay and mortality were comparable in the two groups. A full trauma list accounted for the most frequent orthopaedic delay, which decreased from 18.1% to 12.9% (p = 0.09). Increased recognition of medical comorbidity has financial implications for hospital remuneration. However, lack of orthopaedic provisions accounts for significant avoidable surgical delay requiring further investment if national standards are to be achieved.
Trauma and Orthopaedic Department, Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire, UK. danielmarsland@yahoo.co.uk
Daniel
D
Marsland
Carolyn
C
Chadwick
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D005853:Geriatrics; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006299:Health Services for the Aged; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010348:Patient Care Team; D011300:Preoperative Care; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology