A Multicenter Study on Definitive Surgery for Isolated Hip Fracture within 24 Hours.


North Florida


Ocala Regional Medical Center

Document Type


Publication Date



bone fractures, wounds and injuries, hip fractures, aged, mortality


Quality Improvement | Surgery | Trauma


INTRODUCTION: Isolated hip fractures (IHFs) in the elderly are high frequency, life-altering events. Definitive surgery ≤ 24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery < 24 hours was developed for a multi-hospital network. We report on its feasibility and subsequent patient outcomes.

METHODS: This is a prospective multicenter cohort study, involving 85 level 1, 2, 3, and 4 Trauma Centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: 1) hospitals that did not implement any PMG; 2) hospitals that used their own PMG; 3) hospitals that partially used the network IHF-PMG; and 4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05.

RESULTS: Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively.

CONCLUSION: Goal directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality.Level of Evidence and Study TypeLevel III Cohort Study.

Publisher or Conference

Journal of Trauma and Acute Care Surgery