Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-28T01:54:40.248Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving hip fracture care: striving for excellence

Published online by Cambridge University Press:  01 July 2013

N Nandi ,
M Maddula  and
O Sahota
N Nandi
Affiliation:
Nottingham University Hospitals NHS Trust, Nottingham, UK
M Maddula
Affiliation:
Nottingham University Hospitals NHS Trust, Nottingham, UK
O Sahota*
Affiliation:
Nottingham University Hospitals NHS Trust, Nottingham, UK
*
Address for correspondence: Professor Opinder Sahota, Health Care for the Older Person, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Hip fracture is a common and potentially devastating injury that occurs mainly in older people. The incidence is predicted to rise by 30% in the next 10 years alone. Many of those who recover suffer a loss of mobility and independence. There is growing emphasis to improve the care of patients sustaining hip fracture, especially in those with concurrent cognitive impairment. This review focuses on current best practice as well as several key areas of management, including analgesia, anaemia and nutrition. In doing so, we hope to identify interventions that may form the basis of a future Enhanced Recovery Pathway dedicated to hip fracture care.

Keywords

hip fractureenhanced recovery after surgeryanaemiaanalgesianutritioncarbohydrate loadingdementiadeliriummultidisciplinary rehabilitation
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 3 , August 2013 , pp. 223 - 233
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1National Institute for Health and Clinical Excellence. The management of hip fracture in adults. Guideline 124. June 2011. Available at: http://www.nice.org.uk/nicemedia/live/13489/54918/54918.pdf (accessed 2 April 2013).Google Scholar
2British Orthopaedic Association., 2007. The care of patients with fragility fractures. Available at: http://www.fractures.com/pdf/BOA-BGS-Blue-Book.pdf (accessed 2 April 2013).Google Scholar
3National Hip Fracture Database National Report, 2012. Available at: http://www.nhfd.co.uk/ (accessed 2 April 2013).Google Scholar
4Roche, JJW, Wenn, RT, Sahota, O, Moran, CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: postoperative observational cohort study. BMJ 2005; 331: 1374.CrossRefGoogle ScholarPubMed
5Magaziner, J, Fredman, L, Hawkes, Wet al.Changes in functional status attributable to hip fracture (a comparison of hip fracture patients to community-dwelling aged). Am J Epidemiol 2003; 157: 1023–31.CrossRefGoogle ScholarPubMed
6Bertram, M, Norman, R, Kemp, L, Vos, T. Review of the long-term disability associated with hip fractures. Inj Prev 2011; 17: 365–70.CrossRefGoogle ScholarPubMed
7Marks, R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 2010; 3: 1–17.Google ScholarPubMed
8Department of Health, 2009. Prevention Package for Older People. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/en/index.htm (accessed 2 March 2013).Google Scholar
9Ljungqvist, O. ERAS – Enhanced Recovery After Surgery. J Visceral Surg 2011; 148: e157–59.CrossRefGoogle ScholarPubMed
101000 Lives of Fywydau, 2011. Enhanced Recovery After Surgery. Available at: http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/How%20to%20%2816%29%20ERAS%20%28Feb%202011%29%20Web.pdf (accessed 2 April 2013).Google Scholar
11National Institute for Health and Clinical Excellence. QS 16. Quality standard for hip fracture. March 2012. Available at: http://guidance.nice.org.uk/QS16 (accessed 10 April 2013).Google Scholar
12National Institute of Clinical Excellence. CMG 46. Management of hip fracture in adults. November 2012. Available at: http://www.nice.org.uk/usingguidance/commissioningguides/hipfracture/ManagementOfHipFractureInAdults.jsp (accessed 10 April 2013).Google Scholar
13Department of Health. Policy paper. Healthy lives, Healthy people: Improving outcomes and supporting transparency. January 2012. Available at: https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency (accessed 10 April 2013).Google Scholar
14Department of Health. Guidance. NHS Outcomes Framework 2012 to 2013. December 2011. Available at: https://www.gov.uk/government/publications/nhs-outcomes-framework-2012-to-2013 (accessed 10 April 2013).Google Scholar
15Department of Health. Policy paper. The Adult and Social Care Outcomes Framework 2013 to 2014. November 2012. Available at: https://www.gov.uk/government/publications/the-adult-social-care-outcomes-framework-2013-to-2014 (accessed 10 April 2013).Google Scholar
16National Institute for Health and Clinical Excellence. About the Clinical Commissioning Group Outcomes Indicator set (CCGOIS). Available at: http://www.nice.org.uk/aboutnice/cof/cof.jsp (accessed 10 April 2013).Google Scholar
17National Institute for Health and Clinical Excellence. About the Quality and Outcomes Framework (QOF). Available at: http://www.nice.org.uk/aboutnice/qof/qof.jsp (accessed 10 April 2013).Google Scholar
18Kammerlander, C, Roth, T, Friedman, SMet al.Ortho-geriatric service – a literature review comparing different models. Osteoporos Int 2010; 21 (suppl 4): s637–46.CrossRefGoogle Scholar
19Pioli, G, Giusti, A, Barone, Aet al.Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res 2008; 20: 113–22.CrossRefGoogle ScholarPubMed
20Oliver, D, Griffiths, R, Roche, J, Sahota, O. Hip Fracture. Clin Evid 2010; 5: 1110.Google Scholar
21Handoll, HHG, Cameron, ID, Mak, JCSet al.Multidisciplinary rehabilitation for older people with hip fractures (Review). Cochrane Database Syst Rev 2009; 4: CD007125. doi: 10.1002/14651858.CD007125.pub2.Google Scholar
22De Vries, EN, Prins, HA, Crolla, RMPHet al.Effect of a comprehensive surgical safety system on patient outcomes. New Engl J Med 2010; 363: 1928–37.CrossRefGoogle ScholarPubMed
23Resar, R, Pronovost, P, Haraden, Cet al.Using a bundle approach to improve ventilator care processes and reduce ventilator associated pneumonia. J Quality Patient Safety 2005; 31: 243–48.CrossRefGoogle ScholarPubMed
24Gillespie, R. Prevention and management of ventilator-associated pneumonia – the Care Bundle approach. SAJCC 2009; 25: 44–51.Google Scholar
25Kehlet, H, Wilmore, DW. Fast-track surgery. Br J Surg 2005; 92: 3–4.CrossRefGoogle ScholarPubMed
26Varadhan, K, Neal, KR, Dejong, CHCet al.The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials. Clinical Nutrition 2010; 29: 434–40.CrossRefGoogle ScholarPubMed
27Parker, MJ, Pryor, GA, Myles, J. 11-year results in 2,846 patients of the Peterborough Hip Fracture Project: reduced morbidity, mortality and hospital stay. Acta Orthop Scand 2000; 71: 34–38.CrossRefGoogle Scholar
28Scottish Intercollegiate Guidelines Network, 2009. Management of hip fracture in older people. Guideline 111. Available at: http://www.sign.ac.uk/pdf/sign111.pdf (accessed 2 April 2013).Google Scholar
29Sahota, O, Morgan, N, Moran, CG. The direct cost of acute hip fracture care in care home residents in the UK. Osteoporosis Int 2012; 23: 917–20.CrossRefGoogle ScholarPubMed
30Leung, F, Lau, TW, Kwan, Ket al.Does timing of surgery matter in fragility hip fractures? Osteoporos Int 2010; 21 (suppl 4): s529–34.CrossRefGoogle ScholarPubMed
31Cuvillon, P, Ripart, J, Debureaux, S, Boisson, C, Veyrat, E, Mahamat, Aet al.[Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study]. Ann Fr Anesth Reanim 2007; 26: 2–9.CrossRefGoogle Scholar
32Fischer, B, Simanski, C, on behalf of the PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 2005; 60: 1189–202.CrossRefGoogle ScholarPubMed
33Fischer, HB, Simanski, CJ, Sharp, C, Bonnet, F, Camu, F, Neugebauer, EA, Rawal, N, Joshi, GP, Schug, SA, Kehlet, H. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008; 63: 1105–23.CrossRefGoogle ScholarPubMed
34Singelyn, FJ, Deyaert, M, Joris, D, Pendeville, E, Gouverneur, JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesthesia Analgesia 1998; 87: 88–92.CrossRefGoogle ScholarPubMed
35Parker, MJ, Griffiths, R, Appadu, BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 2002; (1): CD001159. Review.Google Scholar
36Foss, NB, Kristensen, BB, Bundgaard, Met al.Fascia iliaca compartment blockade for acute pain control in hip fracture patients. Anaeths 2007; 106: 773–78.Google ScholarPubMed
37Hauritz, RW, Gerlif, C, Rønholm, E. Fascia iliaca block performed by emergency department physician trainees in hip fractures. Ugeskrift for Laeger 2009; 171: 515–18.Google ScholarPubMed
38Marhofer, P, Schrogendorfer, K, Koinig, H, Kapral, S, Weinstabl, C, Mayer, N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997; 85: 854–57.CrossRefGoogle ScholarPubMed
39Foss, NB, Kristensen, MT, Kristensen, BBet al.Effect of post-operative analgesia on rehabilitation and pain after hip fracture surgery. Anaes 2005; 102: 1197–204.Google Scholar
40Halm, EA, Wang, JW, Boockvar, K. The effect of perioperative anaemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma 2004; 18: 369–74.CrossRefGoogle ScholarPubMed
41Lawrence, VA, Silverstein, JH, Cornell, JEet al.Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43: 1717–22.CrossRefGoogle ScholarPubMed
42Carson, JL, Terrin, ML, Noveck, Het al.Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365: 2453–62.CrossRefGoogle ScholarPubMed
43Carson, JL, Duff, A, Berlin, JAet al.Perioperative blood transfusion and postoperative mortality. JAMA 1998; 279: 199–205.CrossRefGoogle ScholarPubMed
44Madjdpour, C, Spahn, DR. Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesthesia 2005; 95: 33–42.CrossRefGoogle ScholarPubMed
45Koren-Hakim, T, Weiss, A, Hershkovitz, Aet al.The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clinical Nutrition 2012; doi:10.1016/j.clnu.2012.03.010.CrossRefGoogle ScholarPubMed
46Yuill, KA, Richardson, RA, Davidson, et al.The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively – a randomised clinical trial. Clinical Nutrition 2005; 24: 32–37.CrossRefGoogle ScholarPubMed
47Ljungqvist, O, Nygren, J, Thorell, Aet al.Preoperative nutrition – elective surgery in the fed or the overnight fasted state. Clinical Nutrition 2001; 20 (suppl 1): 167–71.CrossRefGoogle Scholar
48Noblett, SE, Watson, DS, Huong, Het al.Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006; 8: 563–69.CrossRefGoogle ScholarPubMed
49Togeir, BW, Leiv, OW, Torbergsen, Aet al.The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatrics 2012; 12: 36.Google Scholar
50Seitz, DP, Adunuri, N, Gill, SS, Rochan, PA. Prevalence of dementia and cognitive impairment among older adults with hip fractures. J Am Med Dir Assoc 2011; 12: 556–64.CrossRefGoogle ScholarPubMed
51Henderson, C, Malley, J, Knapp, M. Maintaining good health for older people with dementia who experience fractured neck of femur: report for phase 2; 2007. National Audit Officer, London, UK.Google Scholar
52Laditka, JN, Laditka, SB, Cornman, CB. Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators. Am J Alzheimers Dis Other Demen 2005; 20: 27–36.CrossRefGoogle ScholarPubMed
53Baker, NL, Cook, MN, Arrighi, HM, Bullock, R. Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007. Age Ageing 2011; 40: 49–54.CrossRefGoogle ScholarPubMed
54Bentler, SE, Liu, L, Obrizan, Met al.The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009; 170: 1290–99.CrossRefGoogle ScholarPubMed
55Cree, M, Carriere, KC, Soskolne, CL, Suarez-Almazor, M. Functional dependence after hip fracture. Am J Phys Med Rehabil 2001; 80: 736–43.CrossRefGoogle ScholarPubMed
56Aharonoff, GB, Barsky, A, Hiebert, Ret al.Predictors of discharge to a skilled nursing facility following hip fracture in New York State. Gerontology 2004; 50: 298–302.CrossRefGoogle ScholarPubMed
57Chen, LT, Lee, JA, Chau, BS, Howe, TS. Hip fractures in the elderly: the impact of comorbid illnesses on hospitalization costs. Ann Acad Med Singapore 2007; 36: 784–87.CrossRefGoogle Scholar
58Lenze, EJ, Munin, MC, Dew, MAet al.Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Int J Geriatr Psychiatry 2004; 19: 472–78.CrossRefGoogle ScholarPubMed
59Samuelson, B, Hedstrom, MI, Ponzer, Set al.Gender differences and cognitive aspects on functional outcome after hip fracture – a 2 years follow up of 2,134 patients. Age Ageing 2009; 38: 686–92.CrossRefGoogle Scholar
60Mitani, S, Shimizu, M, Abo, M, Hagino, H, Kurozawa, Y. Risk factors for second hip fractures among elderly patients. J Orthop Sci 2010; 15: 192–97.CrossRefGoogle ScholarPubMed
61McGilton, KS, Davis, A, Mahomed, Net al.An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012; 12: 21. doi: 10.1186/1471-2318-12-21.CrossRefGoogle ScholarPubMed
62Department of Health, 2009. Living with Dementia: A National Dementia Strategy. Available at: http://www.rcpsych.ac.uk/pdf/National%20Dementia%20Strategy2.pdf (accessed 2 April 2013).Google Scholar
63Morrison, RS, Magaziner, J, Gilbert, Met al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol 2003; 58: 76–81.CrossRefGoogle ScholarPubMed
64National Institute of Health and Clinical Excellence. Delirium: diagnosis, prevention and management. Guideline 103. July 2010. Available at: http://www.nice.org.uk/nicemedia/live/13060/49909/49909.pdf (accessed 2 April 2013).Google Scholar
65Royal College of Physicians. Falling standards, broken promises. Report of the national audit of falls and bone health in older people in 2010. (2011).Google Scholar
66Cole, MG, McCusker, J, Marques Windholz, S. Delirium in older patients: clinical presentation and diagnosis. Rev Esp Geriatr Gerontol 2008; 43 (suppl 3):13–18.Google ScholarPubMed
67Scottish Hip Fracture Audit. The patient journey post hip fracture: What constitutes rehabilitation (2009).Google Scholar
68Goldstein, FC, Strasser, DC, Woodard, JLet al.Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc. 1997; 45: 35–42.CrossRefGoogle ScholarPubMed
69Resnick, B, Daly, MP. The effect of cognitive status on outcomes following rehabilitation. Fam Med 1997; 29: 400–5.Google ScholarPubMed
70Muir, SW, Yohannes, AM. The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 2009; 32: 24–32.CrossRefGoogle ScholarPubMed
71Huusko, TM, Karppi, A, Avikainen, Vet al.Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000; 321: 1107–11.CrossRefGoogle ScholarPubMed
72Stenvall, M, Olofsson, B, Nyberg, Let al.Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomised controlled trial with 1-year follow-up. J Rehabil Med 2007; 39: 232–38.CrossRefGoogle ScholarPubMed
73Stenvall, M, Berggren, M, Lundstrom, Met al.A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia – Subgroup analyses of a randomised controlled trial. Archives Gerontol Geriatrics (2011). doi: 1o.1016/j.archger.2011.08.013.Google Scholar
74Morghen, S, Gentile, S, Ricci, Eet al.Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. JAGS 2011; 59: 1497–502.CrossRefGoogle ScholarPubMed
75Saltvedt, I, Prestmo, A, Einarsen, Eet al.Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Res Notes 2012; 5: 355.CrossRefGoogle Scholar