title: Should hospital managers read the orthopedic literature before surgeons? The example of femur fracture management.
abstract: BACKGROUND
  Early surgical intervention in the treatment of proximal femur fractures has been shown to significantly reduce mortality and complications. Our study intends to evaluate early surgery rates in a single-center analysis before the clinical advantages of early surgical intervention were demonstrated in the literature (G1), after the orthopedic team aimed to treat those fractures within 48 h (G2), and after early intervention became a primary objective for hospital management (G3).
  
  
  METHODS
  The hospital charts of 894 proximal femur fractures in patients aged >65 years between 2008 and 2015 were analyzed in a single teaching hospital. The patients were allocated to three groups according to admission date, relative to the introduction of the different targets for early intervention. Our primary aim was to evaluate the differences in the rate of surgical treatment within 48 h in the three groups, and our secondary aim was to see if those differences influenced clinical outcomes.
  
  
  RESULTS
  The rate of treatment before 48 h was 23, 49 and 72 % in groups 1, 2 and 3, respectively (p < 0.001). There were no statistically significant differences between the three groups regarding time from surgery to discharge and perioperative mortality. The length of hospitalization was different only between groups 1 and 2.
  
  
  CONCLUSIONS
  The adoption of an early treatment goal for proximal femur fractures by the orthopedic team significantly improved the results. However, it was only by introducing this goal into primary hospital management objectives that significantly increased the performance. Level of evidence Level IV (retrospective case-control study).
authors.affiliation: San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole 10, Orbassano, Turin, Italy. ale_aprato@hotmail.com.
authors.forename: Alessandro
authors.identifier: http://orcid.org/0000-0002-2514-4719
authors.initials: A
authors.lastname: Aprato
authors.affiliation: University of Turin, C.so Massimo d'Azeglio 60, Turin, Italy.
authors.forename: Denis
authors.initials: D
authors.lastname: Longo
authors.affiliation: University of Turin, C.so Massimo d'Azeglio 60, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Giachino
authors.affiliation: San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole 10, Orbassano, Turin, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Agati
authors.affiliation: University of Turin, C.so Massimo d'Azeglio 60, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massè
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000071959:Case Managers / Q000193:education / Q000592:standards*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008330:Management Audit / Q000379:methods*; D009985:Orthopedics; D010506:Periodicals as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Early treatment; Elderly; Hip fractures; Public healthcare