Inpatient Isolated Hip Fracture Management: Pre and Post Guideline Implementation
Document Type
Conference Proceeding
Publication Date
5-9-2025
Abstract
Management of isolated hip fractures (IHF) requires coordination of care across multiple specialties with the goal of optimizing patient outcomes. To aid with this, guidelines were developed at our Level 1 trauma center, adopting a co-management hip fracture protocol between Orthopedic Surgery and Internal Medicine. Current literature suggests this strategy streamlines diagnostic and therapeutic steps and has produced positive outcomes. This study aims to compare patient outcome data prior to and following implementation of these guidelines.
This is a retrospective cohort study utilizing our Level 1 trauma center's registry and electronic medical records (EPIC) commencing from 01/01/2018 - 1/31/2020 (pre-protocol) and 08/01/2021 - 03/31/2024. Investigators included a six month "wash out" period after initiation of IHF guidelines to improve compliance. The primary outcome measured was hospital length of stay (LOS).
2,318 patients were identified, 883 in the pre-IHF guideline group and 1,431 in the post implementation group. Median age of all patients was 82 years and ground level fall was the most common mechanism of injury (97%). In-hospital events were similar between the two groups with the exception delirium being reported more in the post implementation group (3.8 vs 0.1%, p < 0.001). Compliance with institutional VTE prophylaxis guidelines was higher in the post group (p < 0.001). Hospital length of stay (LOS) and time to surgery (TTS) were greater in the post-cohort. ICU admission and ICU LOS were similar between groups (Table 1). A greater number of patients were discharged home or home with care post implementation 32% versus pre implementation 20% (p < 0.001). In hospital mortality or discharged to hospice was 3.9% in the pre group and 3.1% in the post group.
Adoption of multidisciplinary IHF management guidelines resulted in an improvement with VTE prophylaxis administration and discharge disposition to home. Surprisingly, an increase in LOS and TTS were found after implementation and aside from delirium, no significant change in events measured was determined. Thus, there are likely other factors in play which have a greater role in outcome determination. Further study aiming to drill down into these factors is being undertaken.
Recommended Citation
Gentile J, Albrecht A, Carrier E, Franklyn A, Pounders S, Sellers L, Krech L, Phad M, Steensma E. Inpatient isolated hip fracture management: pre and post guideline implementation. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1859