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Open Access 01-12-2019 | Care | Research article

Fast track hip fracture care and mortality – an observational study of 2230 patients

Authors: Christian Thomas Pollmann, Jan Harald Røtterud, Jan-Erik Gjertsen, Fredrik Andreas Dahl, Olav Lenvik, Asbjørn Årøen

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Abstract

Background

Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures.

Methods

Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression.

Results

Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p < 0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15–0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis (p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63–1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group.

Conclusions

Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care.

Trial registration

The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907) 6 December 2016.

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Title: Fast track hip fracture care and mortality – an observational study of 2230 patients
Authors: Christian Thomas Pollmann
Jan Harald Røtterud
Jan-Erik Gjertsen
Fredrik Andreas Dahl
Olav Lenvik
Asbjørn Årøen
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-019-2637-6

At a glance: The STEP trials

Springer Medicine

Fast track hip fracture care and mortality – an observational study of 2230 patients

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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