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


North Florida



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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