Hip fractures in older patients: analysing the activity of an orthopaedic department to design an optimized pathway of fracture care

IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
H. Temido, E. Coeckelberghs, R. Ramalho, R. Cavaca, A. Henriques, F. Fonseca, P. Boto
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Abstract

Summary

Substandard management of hip fractures in older patients has serious consequences in outcomes. Assessing care provided and institutional characteristics is essential to identify aspects to improve for better results. Delay to surgery, inadequate pain management, and delay in urinary catheter removal were especially inadequate and needed correction to better patient recovery.

Introduction

Hip fractures in older patients are a public health issue due to their prevalence and consequences. This study is an assessment of treatment currently provided to older patients with hip fractures in a tertiary hospital as a way of measuring standard care and guiding the design of a hospital-specific care pathway for the treatment of these patients.

Methods

A total of 250 patients over 65 years old were analysed. The overall population and its subgroups (early or late surgery and admitted to orthopaedic or non-orthopaedic ward) were characterized through descriptive statistical analysis, and the results were compared through inferential and regression analysis.

Results

Aspects requiring improvement were identified: inadequate pain management in the emergency department, increased time to surgery, excessive length of stay, increased time to first ambulation and to urinary catheter removal, medical complications and decrease in functional capacity at discharge. The mortality rate at discharge and up to 6 months was similar to what is described in the literature, in spite of the issues identified. Although further analysis is needed, some empirical reasons for these results are proposed.

Discussion

Some of the results described can be attributed to common hospital characteristics or non-modifiable patient characteristics but others can be corrected by suitable interventions.

老年患者髋部骨折:分析骨科活动设计骨折护理优化途径
老年髋部骨折患者的管理不规范会导致严重的后果。评估所提供的护理和机构特征对于确定需要改进的方面以获得更好的结果至关重要。延迟手术,不适当的疼痛管理和延迟尿导管拔出尤其不充分,需要纠正,以更好地恢复患者。老年患者髋部骨折因其发病率和后果而成为一个公共卫生问题。本研究是对目前在三级医院为老年髋部骨折患者提供的治疗进行评估,作为衡量标准护理的一种方式,并指导设计针对这些患者治疗的医院特异性护理途径。方法对250例65岁以上患者的临床资料进行分析。通过描述性统计分析对总体人群及其亚组(手术早期或晚期、骨科病房或非骨科病房)进行特征分析,并通过推理和回归分析对结果进行比较。结果确定了需要改进的方面:急诊科疼痛管理不足,手术时间增加,住院时间过长,首次下床和拔除导尿管时间增加,医疗并发症和出院时功能能力下降。尽管发现了这些问题,但出院时和6个月以内的死亡率与文献中描述的相似。虽然还需要进一步的分析,但本文提出了这些结果的一些实证原因。讨论所描述的一些结果可归因于医院的共同特征或不可改变的患者特征,但其他结果可以通过适当的干预措施加以纠正。
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来源期刊
Archives of Osteoporosis
Archives of Osteoporosis ENDOCRINOLOGY & METABOLISMORTHOPEDICS -ORTHOPEDICS
CiteScore
5.50
自引率
10.00%
发文量
133
期刊介绍: Archives of Osteoporosis is an international multidisciplinary journal which is a joint initiative of the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA. The journal will highlight the specificities of different regions around the world concerning epidemiology, reference values for bone density and bone metabolism, as well as clinical aspects of osteoporosis and other bone diseases.
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