Non-emergency management of hip fractures in older patients.
OBJECTIVE
To evaluate the effects of a policy change from emergency to scheduled management of hip fractures in older patients.


METHODS
91 and 107 patients aged 50 years or older with hip fractures were scheduled for operation on the emergency and orthopaedic lists, respectively. Cancellation rates, consultant supervision rates, after-hour operation rates, 30-day mortality, and preoperative and total length of hospital stay were compared.


RESULTS
When older patients with hip fractures were scheduled on orthopaedic lists rather than emergency lists, the cancellation rates owing to lack of theatre time (4% vs 54%, p<0.001), the supervision rates (45% vs 24%, p=0.002), and after-hour operation rates (1% vs 25%, p<0.001) were significantly better. The 30-day mortality rates decreased from 4.4% to 1.9% (p=0.3). The median preoperative length of hospital stay significantly increased from 2 to 4 days (p=0.046), but the increase in total length of hospital stay was non-significant (6 to 10 days, p=0.14).


CONCLUSIONS
Non-emergency management of hip fractures in older patients resulted in fewer cancellations and after-hour operations, and increased consultant supervision. Nonetheless, extra time slots for operating theatres are required to avoid an associated increase in preoperative and total length of hospital stay.
Adie
Sam
S
South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia. sam.adie@gmail.com
Harris
Ian A
IA
Thorn
Lyndall
L
McEvoy
Lynette
L
Naylor
Justine M
JM
D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D004638:Emergency Treatment; D005260:Female; D006301:Health Services Needs and Demand; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome