Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study.

IF 3.3 Q2 GERIATRICS & GERONTOLOGY
José Luis Dinamarca-Montecinos, Alejandra Leiva Vásquez, Carmelinda Ruggiero, Yasna Barrera Fernández, Rayén Delgado Gac, Ada Carrillo, Gedeón Lazcano Améstica, Daniel Ulloa Vásquez, Fernando Aranda, Andrés Canales Pizarro, Graciela Mardones, Constanza Morales Gherardelli, Victoria Assael Novik, Osvaldo Sepúlveda, Jossie Acuña, Carola Arancibia Aravena, Julio Ibarra, Jack Bell, Emma Sutton
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引用次数: 0

Abstract

Background: Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48-72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.

Objective: To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.

Design: Before-and-after study, between 01/01/2017-09/30/2019; 12 months before and 21 months after implementation.

Setting: Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.

Participants: Anonymised data of 902 hip-fractured older adults (≥ 60 years).

Intervention: Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.

Measurements: Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.

Results: After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).

Conclusion: Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.

背景:髋部骨折会造成高昂的生物医学、社会、功能、组织和经济成本。有各种质量指标来指导其管理。在智利的公共卫生系统中,这一指标的结果并不达标。造成这种情况的原因可能是:在确诊髋部骨折后,许多老年患者首先被转到综合医院,同时等待骨科手术床位:评估立即转入外科医院的方案对老年髋部骨折患者的组织和经济指标的影响:设计:2017年1月1日至2019年9月30日期间的前后对比研究;实施前12个月和实施后21个月:地点:智利老龄化程度较高地区的地区外科医院,负责其指定区域内87%的老年人口:902名髋部骨折老年人(≥60岁)的匿名数据:干预措施:实施一项方案,要求所有老年髋部骨折患者在确诊后立即入住外科医院:测量:未立即入院的髋部骨折患者人数、手术时间、住院总时间和经济成本。进行了正态性检验(Kolmogorov-Smirnov)、非参数检验(Chi-squared)、Mann-Whitney 和 Kruskal-Wallis 检验。使用了中心倾向测量法(中位数和百分位数):方案实施后,第一年和第二年转诊至综合医院的患者比例均有显著下降(方案实施前=37.8%;方案实施后1=27.3%;方案实施后2=23.3%,P=0.000)。手术时间也明显缩短(中位数床日:术前=15,术后1=11,术后2=10,p=0,000)。住院总时间减少了21%(3395个住院日),费用也从13万美元大幅降至3.5万美元(p = 0,000):结论:老年人髋部骨折患者立即入院接受骨科手术治疗可显著减少院间转运、手术时间、住院总时间和直接住院费用。
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来源期刊
Journal of Frailty & Aging
Journal of Frailty & Aging GERIATRICS & GERONTOLOGY-
CiteScore
5.90
自引率
7.70%
发文量
54
期刊介绍: The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons.          The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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