title: A new algorithm for hip fracture surgery. Reoperation rate reduced from 18 % to 12 % in 2,000 consecutive patients followed for 1 year.
abstract: OBJECTIVE
  Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results.
  
  
  METHODS
  2,000 consecutive patients over 50 years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient records.
  
  
  RESULTS
  931 of 1,000 operative procedures were performed according to the algorithm, as compared to only 726 of 1,000 prior to its introduction (p < 0.001). After implementation of the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192 of 1,000 to 105 of 1,000 (p < 0.001). The rate of reoperations declined from 18% to 12% (p < 0.001 in a multiple Cox regression analysis), with a decline of 24% to 18% for intracapsular fractures and a decline of 13% to 7% for extracapsular fractures. The proportion of bed-days caused by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced.
  
  
  CONCLUSIONS
  It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised the rate of supervision and reduced the rate of reoperations. The reduced reoperation rate saved many hospital bed-days.
authors.affiliation: Department of Orthopaedics, Hvidovre University Hospital, Copenhagen, Denmark. hpalm@dadlnet.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Palm
authors.forename: Michael
authors.initials: M
authors.lastname: Krasheninnikoff
authors.forename: Kim
authors.initials: K
authors.lastname: Holck
authors.forename: Tom
authors.initials: T
authors.lastname: Lemser
authors.forename: Nicolai Bang
authors.initials: NB
authors.lastname: Foss
authors.forename: Steffen
authors.initials: S
authors.lastname: Jacobsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Peter
authors.initials: P
authors.lastname: Gebuhr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome