Delay in hip fracture surgery and its outcomes. A reflection

Epidemiology and factors associated with the perioperative course of patients undergoing hip fracture during the initial phase of the state of emergency declared in 2020

Introduction

Currently, there is no gold standard anesthetic plan for elderly patients with hip fractures who must undergo surgery. The state of alarm during 2020 due to the COVID-19 pandemic changed certain hospital paradigms, prompting an investigation into differences in anesthetic management and patient survival for hip fracture surgeries using gamma nail osteosynthesis in 2020 compared to 2019.

Materials and methods

A historical cohort study was conducted to assess morbidity and mortality, with data obtained from anonymized medical records.

Results

Statistically significant differences were found, notably an increase in Body Mass Index during confinement. A statistically significant decrease in leukocyte and hemoglobin levels was observed after surgery. However, there were no statistically significant differences in mortality between 2019 and 2020. Patients who did not require vasoactive drugs during surgery to maintain blood pressure levels above 90/60 mmHg had a better survival rate.

Conclusion

Despite the reduction in postoperative hospital surveillance time, no increase in complications was found. This allowed for early patient reintegration into daily life, early functional rehabilitation, and the minimization of economic costs.

Exploring Barriers to, and Enablers of, Evidence-Informed Hip Fracture Care in Five Low- Middle-Income Countries: China, India, Thailand, the Philippines and Vietnam

Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle‑Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence informed care of patients with fragility fractures, are applicable to these settings. This study utilised semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from eleven hospitals in five countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility, and utilisation of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care.