Implementing, adapting, and validating an evidence-based algorithm for hip fracture surgery.
OBJECTIVE
Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate.


METHODS
Retrospective comparative study.


METHODS
Provincial level III trauma center.


METHODS
The evidence-based "Hvidovre Algorithm" for treatment of hip fractures was adopted and implemented at our provincial institution in September 2008. Three hundred eighty-six consecutive patients older than 50 years admitted with a hip fracture in the first year after implementation were prospectively included and compared with 417 retrospectively included similar patients admitted within the last year before implementation.


METHODS
Implementation of an evidence-based treatment algorithm for hip fracture surgery.


RESULTS
Eighty-five percent (330 of 386) patients were operated according to the algorithm after implementation, compared with 67% (280 of 417) of procedures before implementation (P < 0.001). After implementation, the overall reoperation rate showed a tendency toward a reduction to 8% (32 of 386) from 12% (48 of 417) (P = 0.1). Among all the 803 included patients, the reoperation rate was lower if procedures had been performed according to the algorithm recommendations: 9% (53 of 610) versus 14% (27 of 193) (P = 0.009).


CONCLUSIONS
The algorithm for hip fracture surgery was easily implemented, and our results support that using it facilitates a low reoperation rate. The reoperation rate may be further reduced with higher adherence to algorithm recommendation.


METHODS
Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
*Department of Orthopaedics, Aabenraa Hospital, Aabenraa, Denmark; †Department of Orthopaedics, Hvidovre University Hospital, Hvidovre, Denmark; and ‡Department of Orthopaedics, Odense University Hospital, Odense, Denmark.
Ilija
I
Ban
Henrik
H
Palm
Lasse
L
Birkelund
Jacob
J
Eschen
Søren
S
Kring
Michael
M
Brix
Anders
A
Troelsen
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002985:Clinical Protocols; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D006284:Health Plan Implementation; D006620:Hip Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies