Evidence map›Paper›PMID 30327836›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2019

The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story?

An Sermon, Ine Rochus, Bart Smeets, Willem-Jan Metsemakers, Dominique Misselyn, Stefaan Nijs, Harm Hoekstra

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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. A retrospective chart analysis with 5-year follow-up of early care for geriatric hip fracture patients: why we should continue talking about hip fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024
    Article
  4. When does hip fracture surgery delay affects the length of hospital stay?European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022
    Article
  5. Focus on geriatric trauma.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2019
    Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

An SermonDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Ine RochusDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Bart SmeetsUniversity Hospitals Leuven, Management Information and Reporting, 3000, Leuven, Belgium.
Willem-Jan MetsemakersDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Dominique MisselynDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Stefaan NijsDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Harm HoekstraDepartment of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. harm.hoekstra@uzleuven.be.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTiming of surgery in geriatric hip fracture treatment remains controversial. Early surgery is acknowledged as a quality indicator and NICE guidelines recommend surgery within 0-48 h from admission. In 2014 we implemented the indicator of early surgery in our institution, enhancing operative treatment within the next calendar day. We aimed to evaluate the implementation, define the room for improvement and provide strategies to maintain the quality indicator.

methodsClinical outcome of 744 patients (January 2011-December 2013) before early surgery was implemented, compared to 817 patients (June 2014-May 2017) after implementation of early surgery with a follow-up of 6 months. Data-analysis was done by Pearson's Chi-square test and Mann-Whitney U test.

resultsEarly surgery was achieved in 47.6% and 85.7% in the preimplementation and postimplementation group, respectively (P < 0.001). Both 30 days and 6 months mortality were similar (6.0% vs. 5.4%, P = 0.573 and 18.7% vs. 16.9%, P = 0.355, preimplementation vs. postimplementation, respectively). Early surgery resulted in a significantly shorter total length-of-stay (14 vs. 12 days, P < 0.001, preimplementation vs. postimplementation, respectively). Early surgery did not reduce the readmission rate.

conclusionsThe indicator of early surgery has been successfully implemented. Early surgery resulted in a significantly shorter LOS. No significant reduction in 30 days and 6 months mortality, and 90 days readmission was observed. To maintain early surgery, continuous engagement and monitoring is required by all shareholders involved and if necessary, adjustment of the clinical route is appropriate.

Indexed as

Critical PathwaysAgedAged, 80 and overFemaleGeriatric AssessmentHip FracturesHospital MortalityHumansLength of StayMaleOsteoporotic FracturesOutcome and Process Assessment, Health CarePatient ReadmissionQuality ImprovementRetrospective StudiesTime-to-TreatmentEarly surgeryGeriatric hip fractureQuality indicator

Identifiers

PMID30327836

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.