Trauma
Pia Kjær Kristensen, Raquel Perez-Vicente, George Leckie, Søren Paaske Johnsen, Juan Merlo
Klinisk Epidemiologisk afdeling , Århus Universitetshospital ; Research Unit of Social Epidemiology, Lund University; Centre for Multilevel Modelling, University of Bristol; Danish Center for Clinical Health Services Research, Aalborg University; Research Unit of Social Epidemiology, Lund University
Background: Mortality is a widely used outcome measure when comparing hospital care performance. However, the traditional approach does not explicitly consider scenarios like in hip fracture care, where patients are referred to further care in the municipality after just a few days of hospitalization.
Purpose / Aim of Study: We aimed to estimate both case-mix adjusted hospital and municipality comparisons in order to disentangle the amount of the total patient variation in 1-year mortality that was attributable to the hospital and municipality level, respectively.
Materials and Methods: We determined 1-year mortality risk in patients aged 65 or above with hip fractures registered in Sweden between 2011 and 2014. We performed cross-classified multilevel analysis with 54,999 patients nested within 54 hospitals and 290 municipalities. We adjusted for individual demographic, socioeconomic and clinical characteristics. To quantify the size of the hospital and municipality variation we calculated the variance partition coefficient (VPC) and the area under the receiver operator characteristic curve (AUC).
Findings / Results: The overall 1-year mortality rate was 25.1%. The case-mix adjusted rates varied from 21.7 % to 26.5 % for the 54 hospitals, and from 18.9 % to 29.5 % for the 290 municipalities. The VPC was just 0.2% for the hospital and just 0.1 % for the municipality level. Patient sociodemographic and clinical characteristics were strong predictors of 1-year mortality (AUC = 0.716), but adding the hospital and municipality levels in the cross-classified model only had a minor influence (AUC= 0.718).
Conclusions: Overall in Sweden, one-year mortality after hip-fracture is rather high. However, only a minor part of the patient variation is explained by the hospital and municipality levels. Therefore, special efforts to reduce mortality after hip fracture should be focused on vulnerable patient groups of hip fracture patients wherever they are rather than directed to specific hospitals or municipalities.
Klinisk Epidemiologisk afdeling , Århus Universitetshospital ; Research Unit of Social Epidemiology, Lund University; Centre for Multilevel Modelling, University of Bristol; Danish Center for Clinical Health Services Research, Aalborg University; Research Unit of Social Epidemiology, Lund University
Background: Mortality is a widely used outcome measure when comparing hospital care performance. However, the traditional approach does not explicitly consider scenarios like in hip fracture care, where patients are referred to further care in the municipality after just a few days of hospitalization.
Purpose / Aim of Study: We aimed to estimate both case-mix adjusted hospital and municipality comparisons in order to disentangle the amount of the total patient variation in 1-year mortality that was attributable to the hospital and municipality level, respectively.
Materials and Methods: We determined 1-year mortality risk in patients aged 65 or above with hip fractures registered in Sweden between 2011 and 2014. We performed cross-classified multilevel analysis with 54,999 patients nested within 54 hospitals and 290 municipalities. We adjusted for individual demographic, socioeconomic and clinical characteristics. To quantify the size of the hospital and municipality variation we calculated the variance partition coefficient (VPC) and the area under the receiver operator characteristic curve (AUC).
Findings / Results: The overall 1-year mortality rate was 25.1%. The case-mix adjusted rates varied from 21.7 % to 26.5 % for the 54 hospitals, and from 18.9 % to 29.5 % for the 290 municipalities. The VPC was just 0.2% for the hospital and just 0.1 % for the municipality level. Patient sociodemographic and clinical characteristics were strong predictors of 1-year mortality (AUC = 0.716), but adding the hospital and municipality levels in the cross-classified model only had a minor influence (AUC= 0.718).
Conclusions: Overall in Sweden, one-year mortality after hip-fracture is rather high. However, only a minor part of the patient variation is explained by the hospital and municipality levels. Therefore, special efforts to reduce mortality after hip fracture should be focused on vulnerable patient groups of hip fracture patients wherever they are rather than directed to specific hospitals or municipalities.
Tine Nymark, Niels Dieter Röck, Jens Lauritsen
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Hip fracture patients constitutes one of the largest groups of patients in most of the orthopedic departments, and represents a substantial burden to the health system. It is therefore of interest to study the development of the number of fractures, and the incidence rates. From studies conducted in our department we know, that the annual number of fractures on Funen in the 70’ties was approximately 500 a year and the incidence rates were increasing. Around the millennium, the number was approximately 800 a year and the rates were decreasing. We have found it of interest to follow up on the above mentioned studies.
Purpose / Aim of Study: To compare the incidence rates of hip fractures on Funen from the periods 2000-2003 and 2017-2019 for patients aged 70+, and see if there has been a significant change.
Materials and Methods: Data from the first period are from a study conducted in our department by Nymark et al. Data from the second period are calculated from our local Register, where all patients from Funen (except from the municipalities of Ærø and Middelfart fractures) are included.
Findings / Results: For men aged 70+ the incidence rates for the two periods were 0,83 (C.I. 0,72-0,95) and 0,56 (C.I. 0,48-0,65) and for women aged 70+ 1,86 (C.I. 1,72- 2,01) and 1,01 (C.I. 0,91-1,11) in both cases a significant reduction of 32% and 46%. If the data are split into four age groups 70-79 80-84 85-90 and 90+the same tendency is seen. The age- and sex specific rates have decreased between 18,6 and 54,9% in the 8 groups. The number of patients in the period 2017-19 was 519, 568 and 515 and corrected for inhabitants in the two excluded municipalities: 570, 631 and 572.
Conclusions: The age- and sex specifik incidence rates for hip fractures have fallen significantly from the period 2000-2003 to 2017-2019 in all age groups older than 70. The patient group is still a large group, but the absolute number of fractures has decreased as well, which means that the expected rise, due to an increasing elderly population, has not been seen. It seems as if the general health among the elderly population has improved, and therefore compensated for the forecasted rise in the number of hip fractures.
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Hip fracture patients constitutes one of the largest groups of patients in most of the orthopedic departments, and represents a substantial burden to the health system. It is therefore of interest to study the development of the number of fractures, and the incidence rates. From studies conducted in our department we know, that the annual number of fractures on Funen in the 70’ties was approximately 500 a year and the incidence rates were increasing. Around the millennium, the number was approximately 800 a year and the rates were decreasing. We have found it of interest to follow up on the above mentioned studies.
Purpose / Aim of Study: To compare the incidence rates of hip fractures on Funen from the periods 2000-2003 and 2017-2019 for patients aged 70+, and see if there has been a significant change.
Materials and Methods: Data from the first period are from a study conducted in our department by Nymark et al. Data from the second period are calculated from our local Register, where all patients from Funen (except from the municipalities of Ærø and Middelfart fractures) are included.
Findings / Results: For men aged 70+ the incidence rates for the two periods were 0,83 (C.I. 0,72-0,95) and 0,56 (C.I. 0,48-0,65) and for women aged 70+ 1,86 (C.I. 1,72- 2,01) and 1,01 (C.I. 0,91-1,11) in both cases a significant reduction of 32% and 46%. If the data are split into four age groups 70-79 80-84 85-90 and 90+the same tendency is seen. The age- and sex specific rates have decreased between 18,6 and 54,9% in the 8 groups. The number of patients in the period 2017-19 was 519, 568 and 515 and corrected for inhabitants in the two excluded municipalities: 570, 631 and 572.
Conclusions: The age- and sex specifik incidence rates for hip fractures have fallen significantly from the period 2000-2003 to 2017-2019 in all age groups older than 70. The patient group is still a large group, but the absolute number of fractures has decreased as well, which means that the expected rise, due to an increasing elderly population, has not been seen. It seems as if the general health among the elderly population has improved, and therefore compensated for the forecasted rise in the number of hip fractures.
Niels Dieter Röck, Lasse Pedersen, Jens Lauritsen
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Since 2018 a local interdisciplinary learning and quality team has been working with quality improvements for this patient group. The aim was to comply with the national objectives to reduce the average 30-day and 1 year mortality rate from 10% to 8% and from 28% to 25%, and no department should exceed 9% and 28% respectively. Improvement has focused on rapid preoperative optimization (<4h), early surgery (<24h) and rapid mobilization (<24h after surgery). The LKT tasks were: to review and revise our structured clinical pathway program, to recommend and implement relevant changes into daily practice and to apply data driven quality improvement principles, based on process- and result indicators.
Purpose / Aim of Study: To evaluate the changes in the quality of treatment in the period with a LKT.
Materials and Methods: Data related to patients treated in the dept. in 2017- 2020 (until march 22. 2020)(n=1.657 (590, 636, 580, 151 in the 4 years)). We saw no changes in median age or sex and fracture type distribution in the period. We collected data as required to the national hip fracture register, with local supplements. Mantel- Haenzel Chi2 test for linear trends was applied to examine periodical trends.
Findings / Results: Over the years we saw a decline in both the 30 day- and the 1 year mortality rate (%): 30 days: 9.3 8.3 7.9 and 7.9 (Chi2 = 2.74, p<0.098 n.s.) and 1 year: 26.8 24.2 and 24.8 (Chi2 = 0.82, p<0.365 n.s.). The orthopedic specialist approved surgical indication within 4 hours after admission for 61.5 65.3 72.2 and 75.5 % - an increased non significant trend (Chi2 = 4.69, p<0.030 n.s.) (median: 2.2 1.9 2.1 1.9 h.). 61.5 65.3 72.2 and 87.4 % were operated within 24 hours, an increased significant trend (Chi2 = 4.69, p<10-6)(median: 22.0 21.8 20.0 16.8 h). Mobilization was attained for 78.9 71.7 71.0 and 71.2 % within 24 hours after the operation, a significant negative trend (Chi2 = 8.2, p=0.004) (median: 20.9 21.2 20.9 and 20.2 h).
Conclusions: Most of the process indicators moved in the desired direction and the goals related to mortality was reached. We conclude that the effort of the LKT has had a positive effect, and we will continue the process, to further improve the treatment based on daily data driven management.
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Since 2018 a local interdisciplinary learning and quality team has been working with quality improvements for this patient group. The aim was to comply with the national objectives to reduce the average 30-day and 1 year mortality rate from 10% to 8% and from 28% to 25%, and no department should exceed 9% and 28% respectively. Improvement has focused on rapid preoperative optimization (<4h), early surgery (<24h) and rapid mobilization (<24h after surgery). The LKT tasks were: to review and revise our structured clinical pathway program, to recommend and implement relevant changes into daily practice and to apply data driven quality improvement principles, based on process- and result indicators.
Purpose / Aim of Study: To evaluate the changes in the quality of treatment in the period with a LKT.
Materials and Methods: Data related to patients treated in the dept. in 2017- 2020 (until march 22. 2020)(n=1.657 (590, 636, 580, 151 in the 4 years)). We saw no changes in median age or sex and fracture type distribution in the period. We collected data as required to the national hip fracture register, with local supplements. Mantel- Haenzel Chi2 test for linear trends was applied to examine periodical trends.
Findings / Results: Over the years we saw a decline in both the 30 day- and the 1 year mortality rate (%): 30 days: 9.3 8.3 7.9 and 7.9 (Chi2 = 2.74, p<0.098 n.s.) and 1 year: 26.8 24.2 and 24.8 (Chi2 = 0.82, p<0.365 n.s.). The orthopedic specialist approved surgical indication within 4 hours after admission for 61.5 65.3 72.2 and 75.5 % - an increased non significant trend (Chi2 = 4.69, p<0.030 n.s.) (median: 2.2 1.9 2.1 1.9 h.). 61.5 65.3 72.2 and 87.4 % were operated within 24 hours, an increased significant trend (Chi2 = 4.69, p<10-6)(median: 22.0 21.8 20.0 16.8 h). Mobilization was attained for 78.9 71.7 71.0 and 71.2 % within 24 hours after the operation, a significant negative trend (Chi2 = 8.2, p=0.004) (median: 20.9 21.2 20.9 and 20.2 h).
Conclusions: Most of the process indicators moved in the desired direction and the goals related to mortality was reached. We conclude that the effort of the LKT has had a positive effect, and we will continue the process, to further improve the treatment based on daily data driven management.
Bjarke Viberg, Nickolaj Risbo, Per Hviid Gundtoft, Søren Overgaard, Alma Becic Pedersen
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Surgery for hip fracture in patients treated with new oral anticoagulant (NOAC) is often delayed due to the presumed increased risk of bleeding and mortality. In contrast, surgical delay is associated with an increased mortality in non-NOAC patients.
Purpose / Aim of Study: To assess the association of surgical delay with readmission and mortality in hip fracture patients above 65 years with NOAC treatment.
Materials and Methods: This is a register study from 3 regions during 01.01.2011-31.12.2017. All hip fracture patients with a dispensing for NOAC within 230 days before surgery were included. Primary exposure was surgical delay +/- 36 hours, secondary exposures were delays of <12 hours, 12 to <24 hours, 24 to <36 hours, 36 to <48, and 48 to <72 hours. Transfusion was defined as red blood cell transfusion within 7 days of surgery and readmission as any within 30 days of discharge. We performed Cox regression to estimate adjusted Hazard Ratios (aHR) with 95% confidence intervals adjusting for age, sex, BMI, comorbidity, marital status, type of fracture, type of surgery, year of surgery, region of residence, cohabiting status, and prior medication.
Findings / Results: A total of 911 hip fracture patients in NOAC treatment were identified. There were 63% females and 71% were older than 80 years old. There were 61% patients with a surgical delay less than 36 hours yielding an aHR for transfusion of 0.98 (0.79-1.22), for 30-day mortality 1.39 (0.88-2.17), for 1-year mortality of 1.06 (0.78-1.43), and for any readmission of 1.35 (0.99-1.83) compared to patients operated later than 36 hours. We observed no difference concerning transfusion, 30-day mortality, and 1-year mortality when comparing patients operated with delay of <12 hours, 12 to <24 hours, 24 to <36 hours, and 36 to <48 hours to patients operated between 48 to <72 hours. There is some indication that early surgery <24 hours is associated with increased risk of any readmission.
Conclusions: Surgical delay in NOAC treated patients was not associated with transfusion, 30-day or 1-year mortality. There was an indication of an associated higher risk of readmission with early surgery which could be due a proportion of +90 years patients.
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Surgery for hip fracture in patients treated with new oral anticoagulant (NOAC) is often delayed due to the presumed increased risk of bleeding and mortality. In contrast, surgical delay is associated with an increased mortality in non-NOAC patients.
Purpose / Aim of Study: To assess the association of surgical delay with readmission and mortality in hip fracture patients above 65 years with NOAC treatment.
Materials and Methods: This is a register study from 3 regions during 01.01.2011-31.12.2017. All hip fracture patients with a dispensing for NOAC within 230 days before surgery were included. Primary exposure was surgical delay +/- 36 hours, secondary exposures were delays of <12 hours, 12 to <24 hours, 24 to <36 hours, 36 to <48, and 48 to <72 hours. Transfusion was defined as red blood cell transfusion within 7 days of surgery and readmission as any within 30 days of discharge. We performed Cox regression to estimate adjusted Hazard Ratios (aHR) with 95% confidence intervals adjusting for age, sex, BMI, comorbidity, marital status, type of fracture, type of surgery, year of surgery, region of residence, cohabiting status, and prior medication.
Findings / Results: A total of 911 hip fracture patients in NOAC treatment were identified. There were 63% females and 71% were older than 80 years old. There were 61% patients with a surgical delay less than 36 hours yielding an aHR for transfusion of 0.98 (0.79-1.22), for 30-day mortality 1.39 (0.88-2.17), for 1-year mortality of 1.06 (0.78-1.43), and for any readmission of 1.35 (0.99-1.83) compared to patients operated later than 36 hours. We observed no difference concerning transfusion, 30-day mortality, and 1-year mortality when comparing patients operated with delay of <12 hours, 12 to <24 hours, 24 to <36 hours, and 36 to <48 hours to patients operated between 48 to <72 hours. There is some indication that early surgery <24 hours is associated with increased risk of any readmission.
Conclusions: Surgical delay in NOAC treated patients was not associated with transfusion, 30-day or 1-year mortality. There was an indication of an associated higher risk of readmission with early surgery which could be due a proportion of +90 years patients.
Thomas Giver Jensen, Louise Ørts Vinstrup, Simone Dalskov, Martin Aasbrenn, Henrik Palm, Søren Andreas Rugolo, Merete Thanning Vendelø, Signe Dollerup, Sine Alette Nogel Eriksen, Troels Haxholdt Lunn
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospiatl; Department of Orthopaedic Surgery, Bispebjerg Hospital; Geriatric Research Unit, Department of Geriatrics, Bispebjerg Hospital ; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Emergency Medicine, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital
Background: Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far.
Purpose / Aim of Study: The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for preoperative preparation and surgery compared to a historical control cohort.
Materials and Methods: From March 4, 2019 until June 30, 2019, admission of patients at Copenhagen University Hospital, Bispebjerg, Denmark with a suspected hip fracture triggered an acute hip call. Key personnel are summoned to secure rapid preoperative preparation and surgery. The implementation was defined feasible, if ≥75% of the patients were ready for surgery within four hours and had surgery initiated within 24 hours of hospital arrival. The historical control cohort was patients with hip fractures in the same period in 2018.
Findings / Results: 128 patients were included in 2019, and 99 in 2018. After vs. before hip call, 88% vs. 51% were operated within 24 hours and 96% vs. 79% within 36 hours. Time from admission to surgery (hh:mm) was reduced: Mean difference 10:33 (CI 07:46 – 13:20), p<0.001.
Conclusions: The implementation of a hip call was feasible with 88% of patients with hip fracture being operated within 24 hours, and time for preoperative preparation and surgery was reduced compared with a historical control cohort. Future large-scale studies should clarify potential benefits on clinical outcome.
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospiatl; Department of Orthopaedic Surgery, Bispebjerg Hospital; Geriatric Research Unit, Department of Geriatrics, Bispebjerg Hospital ; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Emergency Medicine, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital
Background: Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far.
Purpose / Aim of Study: The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for preoperative preparation and surgery compared to a historical control cohort.
Materials and Methods: From March 4, 2019 until June 30, 2019, admission of patients at Copenhagen University Hospital, Bispebjerg, Denmark with a suspected hip fracture triggered an acute hip call. Key personnel are summoned to secure rapid preoperative preparation and surgery. The implementation was defined feasible, if ≥75% of the patients were ready for surgery within four hours and had surgery initiated within 24 hours of hospital arrival. The historical control cohort was patients with hip fractures in the same period in 2018.
Findings / Results: 128 patients were included in 2019, and 99 in 2018. After vs. before hip call, 88% vs. 51% were operated within 24 hours and 96% vs. 79% within 36 hours. Time from admission to surgery (hh:mm) was reduced: Mean difference 10:33 (CI 07:46 – 13:20), p<0.001.
Conclusions: The implementation of a hip call was feasible with 88% of patients with hip fracture being operated within 24 hours, and time for preoperative preparation and surgery was reduced compared with a historical control cohort. Future large-scale studies should clarify potential benefits on clinical outcome.
Thomas Johannesson Hjelholt, Søren Paaske Johnsen, Peter Krogh Brynningsen, Alma Becic Pedersen
Department og Clinical Epidemiology, Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University; Department of Geriatrics, Aarhus University Hospital; Department og Clinical Epidemiology, Aarhus University
Background: Patients undergoing hip fracture surgery have an increased risk of stroke, compared to the general population. The CHA2DS2-VASc score has been widely used to assess stroke risk in patients with atrial fibrillation (AF) and could also be used to assess risk of cardiovascular events in hip fracture patients without AF.
Purpose / Aim of Study: Evaluate the association of CHA2DS2-VASc score and stroke, thromboembolism and all-cause mortality in hip fracture patients with or without AF.
Materials and Methods: All incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 were identified using the Danish Multidisciplinary Hip Fracture Registry. Outcomes were ischemic stroke, all thromboembolisms (stroke, myocardial infarction, peripheral arterial embolism or pulmonary embolism), or death. We calculated cumulative incidences and hazard ratios (HR) with 95% confidence intervals, by CHA2DS2-VASc score, stratified on previous history of AF.
Findings / Results: Among 78,096 hip fracture patients, 12,319 (15.8%) had a diagnosis of AF. Only 31 % of patients in the AF- group were treated with anticoagulants at the time of admission. The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA2DS2-VASc score, being 1.9% for patients with a score of 1 and 8.6% for patients with a score of >5 in the AF group. Corresponding incidences in the non-AF group were 1.6% and 7.6%. Compared with a CHA2DS2-VASc score of 1, adjusted HRs were 5.53 (95% CI: 1.37- 22.24) among AF patients and 4.91 (95% CI: 3.40-7.10) among non-AF patients with a score of >5. All-cause mortality risks and HRs were substantially higher for all CHA2DS2-VASc scores above 1 in both the AF and non-AF groups.
Conclusions: Among hip fracture patients, CHA2DS2-VASc score was associated with risk of stroke, thromboembolism and death in patients with and without AF. Patients with high CHA2DS2-VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF. Less than one third of the patients diagnosed with AF were treated with anticoagulants, indicating a very conservative treatment approach in these high-risk patients.
Department og Clinical Epidemiology, Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University; Department of Geriatrics, Aarhus University Hospital; Department og Clinical Epidemiology, Aarhus University
Background: Patients undergoing hip fracture surgery have an increased risk of stroke, compared to the general population. The CHA2DS2-VASc score has been widely used to assess stroke risk in patients with atrial fibrillation (AF) and could also be used to assess risk of cardiovascular events in hip fracture patients without AF.
Purpose / Aim of Study: Evaluate the association of CHA2DS2-VASc score and stroke, thromboembolism and all-cause mortality in hip fracture patients with or without AF.
Materials and Methods: All incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 were identified using the Danish Multidisciplinary Hip Fracture Registry. Outcomes were ischemic stroke, all thromboembolisms (stroke, myocardial infarction, peripheral arterial embolism or pulmonary embolism), or death. We calculated cumulative incidences and hazard ratios (HR) with 95% confidence intervals, by CHA2DS2-VASc score, stratified on previous history of AF.
Findings / Results: Among 78,096 hip fracture patients, 12,319 (15.8%) had a diagnosis of AF. Only 31 % of patients in the AF- group were treated with anticoagulants at the time of admission. The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA2DS2-VASc score, being 1.9% for patients with a score of 1 and 8.6% for patients with a score of >5 in the AF group. Corresponding incidences in the non-AF group were 1.6% and 7.6%. Compared with a CHA2DS2-VASc score of 1, adjusted HRs were 5.53 (95% CI: 1.37- 22.24) among AF patients and 4.91 (95% CI: 3.40-7.10) among non-AF patients with a score of >5. All-cause mortality risks and HRs were substantially higher for all CHA2DS2-VASc scores above 1 in both the AF and non-AF groups.
Conclusions: Among hip fracture patients, CHA2DS2-VASc score was associated with risk of stroke, thromboembolism and death in patients with and without AF. Patients with high CHA2DS2-VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF. Less than one third of the patients diagnosed with AF were treated with anticoagulants, indicating a very conservative treatment approach in these high-risk patients.
Rasmus Elsøe, Isa Motahar, Firas Mahdi, Charlotte Buch Gøthgen, Peter Larsen
Orthopaedic surgery, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Orthopaedic surgery, Aalborg University Hospital, Hjøring; Orthopaedic surgery, Aalborg University Hospital
Background: Soft tissue injuries following lateral tibial plateau fracture affect more than half of patients. Regardless of the type of soft tissue injured, it is still unclear how different treatment strategies influence postoperative outcome.
Purpose / Aim of Study: The aim of this study was to report the 12 months Knee Injury and Osteoarthritis Outcome Score (KOOS5) of patient with surgical managed lateral tibial plateau fractures divided into groups with and without conservatively managed MRI verified soft tissue injuries.
Materials and Methods: Prospective cohort study. Patients treated surgically following a lateral tibial plateau fracture, (AO-41B) between December 2013 and November 2016 were included. Soft tissue injuries were evaluated with preoperative MRI scans. The primary outcome score was the 12 months KOOS5 score divided into groups with and without soft tissue injuries.
Findings / Results: A total of 56 patients were included. Average patient age was 56 years (range 22-86). Thirty-three patients (59%) were female. 50% of patients presented with MRI verified soft tissue injuries. At 12 months postoperatively the mean KOOS5 score for patients with soft tissue injuries was 53.5 (95%CI: 44.8-62.1) and the KOOS5 score for patients without soft tissue injuries was 59.6 (95%CI: 50.7-68.6). No significant difference in the KOOS5 score between patients with and without soft tissue injuries was observed (P=0.31)
Conclusions: Patient-reported outcome 12 months following lateral tibial plateau fractures is not associated to MRI verified soft tissue injuries. More research is needed to investigate the effects of surgical vs. non- surgical treatment strategies of associated soft tissue injuries following lateral tibial plateau fractures.
Orthopaedic surgery, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Orthopaedic surgery, Aalborg University Hospital, Hjøring; Orthopaedic surgery, Aalborg University Hospital
Background: Soft tissue injuries following lateral tibial plateau fracture affect more than half of patients. Regardless of the type of soft tissue injured, it is still unclear how different treatment strategies influence postoperative outcome.
Purpose / Aim of Study: The aim of this study was to report the 12 months Knee Injury and Osteoarthritis Outcome Score (KOOS5) of patient with surgical managed lateral tibial plateau fractures divided into groups with and without conservatively managed MRI verified soft tissue injuries.
Materials and Methods: Prospective cohort study. Patients treated surgically following a lateral tibial plateau fracture, (AO-41B) between December 2013 and November 2016 were included. Soft tissue injuries were evaluated with preoperative MRI scans. The primary outcome score was the 12 months KOOS5 score divided into groups with and without soft tissue injuries.
Findings / Results: A total of 56 patients were included. Average patient age was 56 years (range 22-86). Thirty-three patients (59%) were female. 50% of patients presented with MRI verified soft tissue injuries. At 12 months postoperatively the mean KOOS5 score for patients with soft tissue injuries was 53.5 (95%CI: 44.8-62.1) and the KOOS5 score for patients without soft tissue injuries was 59.6 (95%CI: 50.7-68.6). No significant difference in the KOOS5 score between patients with and without soft tissue injuries was observed (P=0.31)
Conclusions: Patient-reported outcome 12 months following lateral tibial plateau fractures is not associated to MRI verified soft tissue injuries. More research is needed to investigate the effects of surgical vs. non- surgical treatment strategies of associated soft tissue injuries following lateral tibial plateau fractures.
Natascha GK Lange, Pernille Engell Bovbjerg, Niels Dieter Röck, Jens Lauritsen
Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery/dept Clinical Medicine, Odense University Hospital/University of Southern Denmark
Background: Due to the Covid-19 situation in early 2020 several governmental restrictions were imposed on population contacts, transportation, leisure, cultural events etc. Since it is well known that injuries vary with activity, behaviour and circumstances, the restrictions constituted a “natural experiment” which could affect injury occurrence.
Purpose / Aim of Study: To describe the effect of the Covid-19 lockdown on volume, composition, causal pattern and severity of acute injuries treated at an Emergency Department.
Materials and Methods: All first time injury contacts to the emergency department at OUH during two identical 56 day periods (same number of week- and weekend days) in 2019 (Febr. 14th to April 10th) and 2020 (February 13th to April 8th) were included. Two 28 day periods (Split pre/post: 12th of March 2019, 13th of March 2020) gave four periods (2019:p1+p2, 2020: p3+p4), where p4 is after the lockdown. Binary indicators included were: sex, child (age < 15), elderly (age>74), severity (Any “fracture – excl. nose+finger+toe/amputation/nerve lesion”), type: traffic, work, home-work (=private repair and garden work) and area: garden, schools+sports, bar (bars+restaurant+disco). To verify similarity of the before periods, P1 and p3 were compared , and the lockdown effect was analyzed as (p2 vs p4) and (p3 vs p4) by counts, Chi2 tests and Odds Ratios (OR,[95% CI]).
Findings / Results: A slightly larger percentage of traffic injuries (11 vs 8%) was seen in p1 vs p3 (all other indicators: p>0.10). Total number of visits in the four periods (n,avg/day): (2194,78.4), (2442,87.2), (2333,83.3) and (1357,48.5). Highly significant lower n in p4 (p<10-5). Comparison of p3/p4: No difference in sex, child, severity or work. Significant (p<10-3): higher proportion of elderly (OR=1.42,[1.16-1.74]), home-work (OR=2.6,[1.97-3.44]), garden (OR=3.9,(3.1-4.9). Less traffic injuries (OR=0.60,[0.47-0-77]), schools+sports area (OR=0.10,[0.07-0.13]), bars+restaurants (p3:n=60, p4:n=2) (OR=0.06,[0.01-0.23]). The same results were seen for comparison of p2/p4.
Conclusions: The number of injuries treated was about half during the Covid-19 lockdown period. Major changes in the injury composition was observed compared to the same period in 2019 as earlier in 2020.
Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery/dept Clinical Medicine, Odense University Hospital/University of Southern Denmark
Background: Due to the Covid-19 situation in early 2020 several governmental restrictions were imposed on population contacts, transportation, leisure, cultural events etc. Since it is well known that injuries vary with activity, behaviour and circumstances, the restrictions constituted a “natural experiment” which could affect injury occurrence.
Purpose / Aim of Study: To describe the effect of the Covid-19 lockdown on volume, composition, causal pattern and severity of acute injuries treated at an Emergency Department.
Materials and Methods: All first time injury contacts to the emergency department at OUH during two identical 56 day periods (same number of week- and weekend days) in 2019 (Febr. 14th to April 10th) and 2020 (February 13th to April 8th) were included. Two 28 day periods (Split pre/post: 12th of March 2019, 13th of March 2020) gave four periods (2019:p1+p2, 2020: p3+p4), where p4 is after the lockdown. Binary indicators included were: sex, child (age < 15), elderly (age>74), severity (Any “fracture – excl. nose+finger+toe/amputation/nerve lesion”), type: traffic, work, home-work (=private repair and garden work) and area: garden, schools+sports, bar (bars+restaurant+disco). To verify similarity of the before periods, P1 and p3 were compared , and the lockdown effect was analyzed as (p2 vs p4) and (p3 vs p4) by counts, Chi2 tests and Odds Ratios (OR,[95% CI]).
Findings / Results: A slightly larger percentage of traffic injuries (11 vs 8%) was seen in p1 vs p3 (all other indicators: p>0.10). Total number of visits in the four periods (n,avg/day): (2194,78.4), (2442,87.2), (2333,83.3) and (1357,48.5). Highly significant lower n in p4 (p<10-5). Comparison of p3/p4: No difference in sex, child, severity or work. Significant (p<10-3): higher proportion of elderly (OR=1.42,[1.16-1.74]), home-work (OR=2.6,[1.97-3.44]), garden (OR=3.9,(3.1-4.9). Less traffic injuries (OR=0.60,[0.47-0-77]), schools+sports area (OR=0.10,[0.07-0.13]), bars+restaurants (p3:n=60, p4:n=2) (OR=0.06,[0.01-0.23]). The same results were seen for comparison of p2/p4.
Conclusions: The number of injuries treated was about half during the Covid-19 lockdown period. Major changes in the injury composition was observed compared to the same period in 2019 as earlier in 2020.
Jonas Adjal, Ilija Ban
Orthopaedic Department, CORH, Hvidovre Hospital; Orthopaedic Department, CORH, Hvidovre Hospital
Background: Patella fractures requiring surgery are traditionally treated using metallic implants which are associated with high re-operations rates mainly due to implant prominence. Non- metallic fixation methods could be a solution to this problem.
Purpose / Aim of Study: To report results on adults with a patella fracture treated with a new non-metallic fixation method, the “KnotMe” technique.
Materials and Methods: From 1st of November 2018 all adult patients with a patella fracture requiring surgery was treated with the novel “KnotMe” technique. Prior to surgery all were informed of this experimental technique and the possibility to be treated with the standard metallic tension band technique. 24 patients were enrolled consecutively by the end of august 2019 with no patients declining the “KnotMe” treatment. We had no exclusion criteria regarding high age, fracture type, or functional level. 2 surgeons performed the surgery. The standardized postoperative regimen comprised partial knee immobilization for 4 weeks. Follow-up was done at 2 and 4 weeks and 3 and 6 months post-surgery.
Findings / Results: No patients were lost to follow-up. 15 of 24 were females, median age of 59 years (19-81 years), and 8 open fractures. Fractures were simple 2-part in 5 cases and comminuted in 19 cases. In one case additional k-wires were needed for stability due to severe comminution. At 6 months the median knee ROM was 125 degrees (90-150), median pain VAS at rest was 0,3 (0-2), median pain VAS at activity was 1,2 (0-5). Data on VAS were missing on two patients. All but 1 united radiologically. 7 patients had unexpected events (1 with asymptomatic non-union needing no further intervention, 2 with superficial wound infections treated successfully with oral antibiotics, 1 with prominent knots requiring implant removal, 2 with inflammation of the quadriceps tendon requiring corticoid injections and prolonged rehabilitation, 1 with deep venous thrombosis requiring oral antithrombotic medication).
Conclusions: The "KnotMe" technique seems to be a safe alternative fixation method for all types of patella fractures with a potential to significantly reduce the problem of prominent implants.
Orthopaedic Department, CORH, Hvidovre Hospital; Orthopaedic Department, CORH, Hvidovre Hospital
Background: Patella fractures requiring surgery are traditionally treated using metallic implants which are associated with high re-operations rates mainly due to implant prominence. Non- metallic fixation methods could be a solution to this problem.
Purpose / Aim of Study: To report results on adults with a patella fracture treated with a new non-metallic fixation method, the “KnotMe” technique.
Materials and Methods: From 1st of November 2018 all adult patients with a patella fracture requiring surgery was treated with the novel “KnotMe” technique. Prior to surgery all were informed of this experimental technique and the possibility to be treated with the standard metallic tension band technique. 24 patients were enrolled consecutively by the end of august 2019 with no patients declining the “KnotMe” treatment. We had no exclusion criteria regarding high age, fracture type, or functional level. 2 surgeons performed the surgery. The standardized postoperative regimen comprised partial knee immobilization for 4 weeks. Follow-up was done at 2 and 4 weeks and 3 and 6 months post-surgery.
Findings / Results: No patients were lost to follow-up. 15 of 24 were females, median age of 59 years (19-81 years), and 8 open fractures. Fractures were simple 2-part in 5 cases and comminuted in 19 cases. In one case additional k-wires were needed for stability due to severe comminution. At 6 months the median knee ROM was 125 degrees (90-150), median pain VAS at rest was 0,3 (0-2), median pain VAS at activity was 1,2 (0-5). Data on VAS were missing on two patients. All but 1 united radiologically. 7 patients had unexpected events (1 with asymptomatic non-union needing no further intervention, 2 with superficial wound infections treated successfully with oral antibiotics, 1 with prominent knots requiring implant removal, 2 with inflammation of the quadriceps tendon requiring corticoid injections and prolonged rehabilitation, 1 with deep venous thrombosis requiring oral antithrombotic medication).
Conclusions: The "KnotMe" technique seems to be a safe alternative fixation method for all types of patella fractures with a potential to significantly reduce the problem of prominent implants.
Anders Bo Rønnegaard, Per Hviid Gundtoft, Peter Toft Tengberg, Bjarke Viberg
Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt & Odense University Hospital
Background: The Danish Fracture Database (DFDB) has delivered data for numerous studies and currently there are more than 75,000 fracture- related surgical procedures registered. However, the validity of the data is only known for two hospitals.
Purpose / Aim of Study: To determine validity of the Danish Fracture Database.
Materials and Methods: All patients in the Region of Southern Denmark registered with a primary or planned secondary procedure in the DFDB in 2016 were included. For validity, patient medical records were assessed using a sample of 10% of the study population. The sample was randomly selected and stratified according to anatomical region and treating hospital. Validity was calculated as positive predictive value (PPV) and negative predictive value (NPV) for dichotomous variables. For non-dichotomous variables validity was calculated as the percentage of conformity between the DFDB and patient medical records. Key variables were identified as date of surgery, operated side, and type of surgery. For type of surgery, validity was defined as the presence of the correct type of surgery in DFDB, regardless of other types of surgery registered. Observations that were unavailable in patient medical records or containing missing values were excluded.
Findings / Results: The sample population consisted of 429 patients. The mean age was 55 years (3-98 years) and 43.1% were male. Conformity for key variables was 96% for date of surgery, 97% for operated side of the patient, and 98% for type of surgery. Dichotomous variables had a PPV ranging from 81% to 100% with trauma status at 81% and pathological fracture at 100% (n=1). NPV ranged from 89.5% to 100% with antibiotic prophylaxis at 89.5% and pathological fracture at 100%. For variables other than trauma status, PPV was more than 95% and for variables other than antibiotic prophylaxis, NPV was more than 99%. Validity in percentage of conformity ranged from 84% for ASA score to 100% for location of periprosthetic fracture (n=2). For variables other than ASA score, conformity was more than 93%.
Conclusions: This indicates that the DFDB in general has high validity and we expect the nationwide results to be comparable (will be presented at the congress).
Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt & Odense University Hospital
Background: The Danish Fracture Database (DFDB) has delivered data for numerous studies and currently there are more than 75,000 fracture- related surgical procedures registered. However, the validity of the data is only known for two hospitals.
Purpose / Aim of Study: To determine validity of the Danish Fracture Database.
Materials and Methods: All patients in the Region of Southern Denmark registered with a primary or planned secondary procedure in the DFDB in 2016 were included. For validity, patient medical records were assessed using a sample of 10% of the study population. The sample was randomly selected and stratified according to anatomical region and treating hospital. Validity was calculated as positive predictive value (PPV) and negative predictive value (NPV) for dichotomous variables. For non-dichotomous variables validity was calculated as the percentage of conformity between the DFDB and patient medical records. Key variables were identified as date of surgery, operated side, and type of surgery. For type of surgery, validity was defined as the presence of the correct type of surgery in DFDB, regardless of other types of surgery registered. Observations that were unavailable in patient medical records or containing missing values were excluded.
Findings / Results: The sample population consisted of 429 patients. The mean age was 55 years (3-98 years) and 43.1% were male. Conformity for key variables was 96% for date of surgery, 97% for operated side of the patient, and 98% for type of surgery. Dichotomous variables had a PPV ranging from 81% to 100% with trauma status at 81% and pathological fracture at 100% (n=1). NPV ranged from 89.5% to 100% with antibiotic prophylaxis at 89.5% and pathological fracture at 100%. For variables other than trauma status, PPV was more than 95% and for variables other than antibiotic prophylaxis, NPV was more than 99%. Validity in percentage of conformity ranged from 84% for ASA score to 100% for location of periprosthetic fracture (n=2). For variables other than ASA score, conformity was more than 93%.
Conclusions: This indicates that the DFDB in general has high validity and we expect the nationwide results to be comparable (will be presented at the congress).
Nanna S. Smidt, Line L. Nielsen, Julie L. Erichsen, Henrik Palm, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: Undisplaced femoral neck fractures (uFNFs) are traditionally classified using the Garden classification. However, in 2009 Palm et al. suggested a new measurement of posterior tilt of the femoral head on a lateral radiograph and using this as a predictor of the outcome following osteosynthesis of uFNFs. Several studies have since been perfomed but there has yet to be conducted a pooled analysis.
Purpose / Aim of Study: To conduct a systematic review on the effect of posterior tilt on reoperations, patient related outcome measures (PROM) and functional outcome following osteosynthesis of uFNFs.
Materials and Methods: A search string was developed in collaboration with a scientific librarian and studies were extracted from the PubMed, CINAHL and Embase databases. Supplementary search was performed in Google Scholar. Studies were screened by two independent readers using Covidence. References of included studies were screened as well as studies citing the included studies using Web of Science. The present study was registered in Prospero. Data were extracted for the final analysis and a quality assessment was performed using Robins-I tool. Pooled data was assessed for heterogeneity using Chi2 and I2 tests. A Random-effects model was used to estimate risk ratio.
Findings / Results: 10 cohort studies with 3699 patients were included. The mean age was 76 years and 72% were female. In general, the studies were assessed to be of poor quality mainly due possible bias and confounding. 10.9% reoperations were identified, but there were 10.3% reoperations in the group with posterior tilt <20 degrees whereas there were 24.5% in the group with posterior tilt >20 degrees. The meta- analysis revealed an overall risk ratio of 0.11 (95% confidence interval; 0.04-0.18) for failure with a posterior tilt >20 degrees. Only one study investigated functional outcome using ADL as measurement but found no significant difference. No studies investigated PROM.
Conclusions: A posterior tilt >20 degrees leads to a higher risk of reoperations in uFNF. Even though the studies were of poor quality, the results suggest that we should include measuring posterior tilt in uFNF.
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: Undisplaced femoral neck fractures (uFNFs) are traditionally classified using the Garden classification. However, in 2009 Palm et al. suggested a new measurement of posterior tilt of the femoral head on a lateral radiograph and using this as a predictor of the outcome following osteosynthesis of uFNFs. Several studies have since been perfomed but there has yet to be conducted a pooled analysis.
Purpose / Aim of Study: To conduct a systematic review on the effect of posterior tilt on reoperations, patient related outcome measures (PROM) and functional outcome following osteosynthesis of uFNFs.
Materials and Methods: A search string was developed in collaboration with a scientific librarian and studies were extracted from the PubMed, CINAHL and Embase databases. Supplementary search was performed in Google Scholar. Studies were screened by two independent readers using Covidence. References of included studies were screened as well as studies citing the included studies using Web of Science. The present study was registered in Prospero. Data were extracted for the final analysis and a quality assessment was performed using Robins-I tool. Pooled data was assessed for heterogeneity using Chi2 and I2 tests. A Random-effects model was used to estimate risk ratio.
Findings / Results: 10 cohort studies with 3699 patients were included. The mean age was 76 years and 72% were female. In general, the studies were assessed to be of poor quality mainly due possible bias and confounding. 10.9% reoperations were identified, but there were 10.3% reoperations in the group with posterior tilt <20 degrees whereas there were 24.5% in the group with posterior tilt >20 degrees. The meta- analysis revealed an overall risk ratio of 0.11 (95% confidence interval; 0.04-0.18) for failure with a posterior tilt >20 degrees. Only one study investigated functional outcome using ADL as measurement but found no significant difference. No studies investigated PROM.
Conclusions: A posterior tilt >20 degrees leads to a higher risk of reoperations in uFNF. Even though the studies were of poor quality, the results suggest that we should include measuring posterior tilt in uFNF.
Jan Duedal Rölfing, Rune Dall Jensen, Charlotte Paltved
Ortopædkirurgi, Aarhus Universitetshospital, Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt
Background: Virtual reality simulation of hip fracture surgery is available for orthopaedic residents in Denmark. Summative assessment of learning applying the learning curve cumulative summation test (LC- CUSUM) has not been utilized in orthopaedic simulation training. The strength of the LC-CUSUM is that it assumes incompetency and signals competency based on solid statistics. The present study HipSim investigates the LC-CUSUM characteristics of novices stepwise mastering the simulated dynamic hip screw (DHS) procedure.
Purpose / Aim of Study: The aim of this study was to describe the LC- CUSUM characteristics of DHS simulation training (HipSim) of 1st-year-orthopaedic residents and associate the results with the participants’ career status after ≥2 years follow-up.
Materials and Methods: Thirty-two 1st-year-orthopaedic residents participated in HipSim and its three subsequent LC- CUSUM evaluations: placing a Kirschner wire, placing a Kirschner wire in different patients, and performing the entire DHS procedure in different patients. The career status of the participants, i.e. still working in orthopaedics or another specialty was recorded ≥2 years after participation and associated with the simulation performance (passed/failed).
Findings / Results: 13/14 participants passing HipSim according to LC- CUSUM were still working in orthopaedics, while 9/18 participants failing HipSim had quit orthopaedics at ≥2 years follow-up. None of the simulator-generated feedback differed statistical significantly between the groups and all participants achieved a tip apex distance ≤ 20 mm.
Conclusions: LC-CUSUM and its summative pass/fail assessment of each simulation was feasible in this formative simulation program. Clinical educators can be reassured that participants passing HipSim are likely to continue to 2nd-5th-year of residency, while failing HipSim should raise concerns and career counseling and close clinical supervision seem to be appropriate measures. The motivational aspect of LC-CUSUM pass/fail assessment when designing formative simulation training warrants further research.
Ortopædkirurgi, Aarhus Universitetshospital, Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt
Background: Virtual reality simulation of hip fracture surgery is available for orthopaedic residents in Denmark. Summative assessment of learning applying the learning curve cumulative summation test (LC- CUSUM) has not been utilized in orthopaedic simulation training. The strength of the LC-CUSUM is that it assumes incompetency and signals competency based on solid statistics. The present study HipSim investigates the LC-CUSUM characteristics of novices stepwise mastering the simulated dynamic hip screw (DHS) procedure.
Purpose / Aim of Study: The aim of this study was to describe the LC- CUSUM characteristics of DHS simulation training (HipSim) of 1st-year-orthopaedic residents and associate the results with the participants’ career status after ≥2 years follow-up.
Materials and Methods: Thirty-two 1st-year-orthopaedic residents participated in HipSim and its three subsequent LC- CUSUM evaluations: placing a Kirschner wire, placing a Kirschner wire in different patients, and performing the entire DHS procedure in different patients. The career status of the participants, i.e. still working in orthopaedics or another specialty was recorded ≥2 years after participation and associated with the simulation performance (passed/failed).
Findings / Results: 13/14 participants passing HipSim according to LC- CUSUM were still working in orthopaedics, while 9/18 participants failing HipSim had quit orthopaedics at ≥2 years follow-up. None of the simulator-generated feedback differed statistical significantly between the groups and all participants achieved a tip apex distance ≤ 20 mm.
Conclusions: LC-CUSUM and its summative pass/fail assessment of each simulation was feasible in this formative simulation program. Clinical educators can be reassured that participants passing HipSim are likely to continue to 2nd-5th-year of residency, while failing HipSim should raise concerns and career counseling and close clinical supervision seem to be appropriate measures. The motivational aspect of LC-CUSUM pass/fail assessment when designing formative simulation training warrants further research.
Morten Tange Kristensen, Jeppe Damgren Vesterager, Alma Becic Pedersen
PMR-C, Departments of Physiotherapy and Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
Background: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture (HF). However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.
Purpose / Aim of Study: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-acquired infections within 30-days of hospital discharge after a first time HF.
Materials and Methods: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from Jan. 2016 through Dec. 2016, we included 5,330 patients. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated (based on ICD-codes) or community-acquired infection (based on antibiotic dispensing’s). HRs were adjusted for sex, age, body mass index, Charlson Comorbidity Index, type of fracture, and length of hospital stay.
Findings / Results: Total of 3,261 (61%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 7.3% sustained a hospital-treated infection compared to 5% of those who did not. Correspondingly, 11.4% versus 7.8% sustained a community-acquired infection. The risk of 30-day post-discharge infection increased with loss of pre-fracture CAS status. The adjusted HRs for hospital-treated and community-acquired infection were 1.35 (CI: 1.04-1.76) and 1.55 (CI: 1.24-1.92), respectively, for patients who had lost their pre-fracture CAS status, compared to patients who did not.
Conclusions: In this large national HF registry study, we found that any loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings underscore the clinical importance of carefully focusing on regaining the pre-fracture basic mobility status before discharging the patient.
PMR-C, Departments of Physiotherapy and Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
Background: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture (HF). However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.
Purpose / Aim of Study: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-acquired infections within 30-days of hospital discharge after a first time HF.
Materials and Methods: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from Jan. 2016 through Dec. 2016, we included 5,330 patients. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated (based on ICD-codes) or community-acquired infection (based on antibiotic dispensing’s). HRs were adjusted for sex, age, body mass index, Charlson Comorbidity Index, type of fracture, and length of hospital stay.
Findings / Results: Total of 3,261 (61%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 7.3% sustained a hospital-treated infection compared to 5% of those who did not. Correspondingly, 11.4% versus 7.8% sustained a community-acquired infection. The risk of 30-day post-discharge infection increased with loss of pre-fracture CAS status. The adjusted HRs for hospital-treated and community-acquired infection were 1.35 (CI: 1.04-1.76) and 1.55 (CI: 1.24-1.92), respectively, for patients who had lost their pre-fracture CAS status, compared to patients who did not.
Conclusions: In this large national HF registry study, we found that any loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings underscore the clinical importance of carefully focusing on regaining the pre-fracture basic mobility status before discharging the patient.
Pia Kjær Kristensen, Nickolaj Risbo, Alma Becic Pedersen
Klinisk Epidemiologisk afdeling , Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital
Background: Surgery for hip fractures frequently requires red blood cell (RBC) transfusion in order to treat pre- existing and acute acquired anemia and operative bleeding. Postoperative anemia in hip fracture patients is associated with reduced rehabilitation and functional independence, as well as increased mortality. However, the indications for RBC transfusion in elderly with hip fractures had not been standardized.
Purpose / Aim of Study: We examined the variation in use of RBC transfusion within seven days after hip fracture surgery across orthopaedic departments in Denmark.
Materials and Methods: In this nationwide population-based cohort study, patients who underwent surgery for an incident hip fracture in 2016 and 2017 (n=11,372) were identified in the Danish Multidisciplinary Hip Fracture Registry. Data on RBC transfusion were obtained from the Danish Transfusion Database. The outcome was defined as RBC transfusion within 7 days after hip fracture surgery (yes/no), and the prevalence of RBC transfusion was estimated overall and among 21 orthopaedic departments in Denmark. In addition, prevalence of RBC transfusion was estimated in patients treated at departments with 30-day morality <8% and >10% in 2016-2017.
Findings / Results: The overall prevalence of RBC transfusion was 32.9 %. However, the unadjusted prevalence of RBC transfusion varied from 19.7% to 72.8% across 21 departments. At Hvidovre orthropaedic department, almost three quarters of hip fracture patients received RBC transfusion, whereas only ever fifth hip fracture patient at Esbjerg orthropaedic department received RBC transfusion. At Aarhus orthropaedic department every second hip fracture patient received transfusion. Among patients treated at departments with 30-day mortality <8%, the prevalence of RBC transfusion was 38.8%, compared with 28.4% among patients treated at departments with 30-day mortality >10%.
Conclusions: We observed a substantial variation in use of RBC transfusion within 7 days after hip fracture surgery among Danish orthopaedic departments. Further analyses to examine characteristics associated with blood transfusion, and the impact of transfusion on prognosis of elderly hip fracture patients is needed.
Klinisk Epidemiologisk afdeling , Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital
Background: Surgery for hip fractures frequently requires red blood cell (RBC) transfusion in order to treat pre- existing and acute acquired anemia and operative bleeding. Postoperative anemia in hip fracture patients is associated with reduced rehabilitation and functional independence, as well as increased mortality. However, the indications for RBC transfusion in elderly with hip fractures had not been standardized.
Purpose / Aim of Study: We examined the variation in use of RBC transfusion within seven days after hip fracture surgery across orthopaedic departments in Denmark.
Materials and Methods: In this nationwide population-based cohort study, patients who underwent surgery for an incident hip fracture in 2016 and 2017 (n=11,372) were identified in the Danish Multidisciplinary Hip Fracture Registry. Data on RBC transfusion were obtained from the Danish Transfusion Database. The outcome was defined as RBC transfusion within 7 days after hip fracture surgery (yes/no), and the prevalence of RBC transfusion was estimated overall and among 21 orthopaedic departments in Denmark. In addition, prevalence of RBC transfusion was estimated in patients treated at departments with 30-day morality <8% and >10% in 2016-2017.
Findings / Results: The overall prevalence of RBC transfusion was 32.9 %. However, the unadjusted prevalence of RBC transfusion varied from 19.7% to 72.8% across 21 departments. At Hvidovre orthropaedic department, almost three quarters of hip fracture patients received RBC transfusion, whereas only ever fifth hip fracture patient at Esbjerg orthropaedic department received RBC transfusion. At Aarhus orthropaedic department every second hip fracture patient received transfusion. Among patients treated at departments with 30-day mortality <8%, the prevalence of RBC transfusion was 38.8%, compared with 28.4% among patients treated at departments with 30-day mortality >10%.
Conclusions: We observed a substantial variation in use of RBC transfusion within 7 days after hip fracture surgery among Danish orthopaedic departments. Further analyses to examine characteristics associated with blood transfusion, and the impact of transfusion on prognosis of elderly hip fracture patients is needed.