Advertisement

A comparative study of hip fracture care and outcomes in major trauma centres versus trauma units

Published:February 09, 2022DOI:https://doi.org/10.1016/j.injury.2022.02.018

      Highlights

      • Following the introduction of MTCs, concerns were raised regarding the effect on hip fracture patients.
      • Using NHFD data we compare outcomes in MTCs vs TUs.
      • There was no statistically significant difference observed in all outcomes for MTC vs TU.
      • FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates.
      • These findings are reassuring for MTCs in England.

      Abstract

      Introduction

      There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns were raised regarding the effect on hip fracture patients. The aim of our study was to review data from the National Hip Fracture Database for fractured neck of femur (FNOF) patients, comparing patient outcomes between MTCs and trauma units (TUs), and the national regions of the UK.

      Methods

      NHFD data from 2018 for all hospitals in England, Wales and NI was collected using the charts and dashboards available online. We recorded data for the following outcomes: time to surgery, acute hospital length of stay, overall hospital length of stay, discharge to original residence within 120 days, crude 30-day mortality and adjusted 30-day mortality. We conducted a one-way ANOVA test to calculate statistical differences for each outcome measure by MTC vs TU and then separately for the regions of the UK divided into England, Wales and Northern Ireland (NI).

      Results

      Data for 175 hospitals are included in this study; 22 of which were MTCs. The total number of operative cases were 65,848. 9668 of these occurred in MTC compared to 56,180 in TUs. This equates to an annual average of 439 per MTC and 367 per TU. Despite this, there was no statistically significant difference observed in all outcomes for MTC vs TU. Patients in NI waited longer for their surgery (60.3 h, p < 0.001), whilst patients in Wales had the longest overall hospital length of stay (31.6 days, p < 0.001). However, there was no difference in patients’ crude 30-day mortality (p = 0.480) or adjusted 30-day mortality (p = 0.191).

      Conclusion

      These findings are reassuring for MTCs in England. We found no evidence to suggest that FNOF patients are treated inferiorly, or have worse outcomes, at MTCs vs TUs. FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates. The care of FNOF patients in NI may warrant further study.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. The national hip fracture database. National hip fracture database national report 2019, 2019.

        • Holt G.
        • Smith R.
        • Duncan K.
        • Hutchison J.D.
        • Reid D.
        Changes in population demographics and the future incidence of hip fracture.
        Injury. 2009; 40 (JulEpub 2009 May 8. PMID: 19426972): 722-726https://doi.org/10.1016/j.injury.2008.11.004
      2. Department of Health. Payment by results guidance for 2010-11. leeds: payment by results team, department of health, 2010

      3. Royal College of Physicians. Best practice tariff (BPT) for fragility hip fracture care user guide, 2010. http://nhfd.co.uk (Accessed 12 July 2020)

        • Oakley B.
        • Nightingale J.
        • Moran C.G.
        • et al.
        Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study.
        BMJ Open. 2017; 7 (Feb 6PMID: 28167748; PMCID: PMC5293976)e014190https://doi.org/10.1136/bmjopen-2016-014190
        • Whitaker S.R.
        • Nisar S.
        • Scally A.J.
        • Radcliffe G.S.
        Does achieving the 'Best Practice Tariff' criteria for fractured neck of femur patients improve one year outcomes?.
        Injury. 2019; 50 (JulEpub 2019 Jun 3. PMID: 31196598): 1358-1363https://doi.org/10.1016/j.injury.2019.06.007
        • Kanakaris N.K.
        • Giannoudis P.V.
        Trauma networks: present and future challenges.
        BMC Med. 2011; 9 (Nov 11PMID: 22078223; PMCID: PMC3229440): 121https://doi.org/10.1186/1741-7015-9-121
        • Celso B.
        • Tepas J.
        • Langland-Orban B.
        • Pracht E.
        • Papa L.
        • Lottenberg L.
        • Flint L
        A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems.
        J Trauma. 2006; 60 (Febdiscussion 378PMID: 16508498): 371-378https://doi.org/10.1097/01.ta.0000197916.99629.eb
        • Beeharry M.W.
        • Moqeem K.
        The London major trauma network system: a literature review.
        Cureus. 2020; 12 (Dec 9PMID: 33324530; PMCID: PMC7732139): e12000https://doi.org/10.7759/cureus.12000
        • Bokhari S.
        • Aslam-Pervez N.
        • Riaz O.
        • Sadozai Z.
        • Bhamra M.
        • Harwood P.
        What effect has the major trauma network had on perceptions of trauma care delivery amongst trauma teams in major trauma centres and neighbouring trauma units?.
        Eur J Trauma Emerg Surg. 2021; 47 (FebEpub 2019 Aug 26. PMID: 31451862): 171-177https://doi.org/10.1007/s00068-019-01206-1
        • Barr L.V.
        • Vindlacheruvu M.
        • Gooding C.R.
        The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients.
        Injury. 2015; 46 (FebEpub 2014 Dec 15. PMID: 25548113): 384-387https://doi.org/10.1016/j.injury.2014.12.005
        • Wong K.
        • Rich J.
        • Yip G.
        • Loizou C.
        • Hull P.
        Management of hip fractures pre- and post-major trauma centre activation.
        Injury. 2015; 46 (OctEpub 2015 Jul 2. PMID: 26169232): 1975-1977https://doi.org/10.1016/j.injury.2015.06.030
        • Metcalfe D.
        • Gabbe B.J.
        • Perry D.C.
        • Harris M.B.
        • Ekegren C.L.
        • Zogg C.K.
        • Salim A.
        • Costa M.L.
        Quality of care for patients with a fracture of the hip in major trauma centres: a national observational study.
        Bone Joint J. 2016; (Mar;98-BPMID: 26920969): 414-419https://doi.org/10.1302/0301-620X.98B3.36904
      4. NHS England. 2016. Major trauma centres in England. [Accessed 13th February 2021] https://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Documents/2016/MTS-map.pdf

        • McCullough A.L.
        • Haycock J.C.
        • Forward D.P.
        • Moran C.G.
        Major trauma networks in England.
        Br J Anaesth. 2014; 113 (AugPMID: 25038152): 202-206https://doi.org/10.1093/bja/aeu204
        • Metcalfe D.
        • Perry D.C.
        • Bouamra O.
        • Salim A.
        • Woodford M.
        • Edwards A.
        • Lecky F.E.
        • Costa M.L.
        Regionalisation of trauma care in England.
        Bone Joint J. 2016; (Sep;98-BPMID: 27587529): 1253-1261https://doi.org/10.1302/0301-620X.98B9.37525
        • Bretherton C.P.
        • Parker M.J.
        Early surgery for patients with a fracture of the hip decreases 30-day mortality.
        Bone Joint J. 2015; (Jan;97-BPMID: 25568422): 104-108https://doi.org/10.1302/0301-620X.97B1.35041
        • Shiga T.
        • Wajima Z.
        • Ohe Y.
        Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.
        Can J Anaesth. 2008; 55 (MarPMID: 18310624): 146-154https://doi.org/10.1007/BF03016088
        • Rai S.K.
        • Varma R.
        • Wani S.S.
        Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome?.
        Eur J Orthop Surg Traumatol. 2018; 28 (FebEpub 2017 Oct 7. PMID: 28988382): 277-282https://doi.org/10.1007/s00590-017-2047-0
        • Leung F.
        • Lau T.W.
        • Kwan K.
        • Chow S.P.
        • Kung A.W.
        Does timing of surgery matter in fragility hip fractures?.
        Osteoporos Int. 2010; 21 (DecSuppl34Epub 2010 Nov 6. PMID: 21057992; PMCID: PMC2974918): S529https://doi.org/10.1007/s00198-010-1391-2
        • Dyer S.M.
        • Crotty M.
        • Fairhall N.
        • Magaziner J.
        • Beaupre L.A.
        • Cameron I.D.
        • Sherrington C.
        • Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
        A critical review of the long-term disability outcomes following hip fracture.
        BMC Geriatr. 2016; 16 (Sep 2PMID: 27590604; PMCID: PMC5010762): 158https://doi.org/10.1186/s12877-016-0332-0
      5. The National Hip Fracture Database. National hip fracture database national Report 2018, 2018.

        • Leal J.
        • Gray A.M.
        • Prieto-Alhambra D.
        • Arden N.K.
        • Cooper C.
        • Javaid M.K.
        • Judge A.
        • REFReSH study group
        Impact of hip fracture on hospital care costs: a population-based study.
        Osteoporos Int. 2016; 27 (FebEpub 2015 Aug 19. PMID: 26286626; PMCID: PMC4740562): 549-558https://doi.org/10.1007/s00198-015-3277-9
      6. National Institute for Health and Care Excellence. Hip fracture: management. Clinical Guideline 124. https://www.nice.org.uk/guidance/cg124. Accessed 20 Jan 2022.

        • Oldmeadow L.B.
        • Edwards E.R.
        • Kimmel L.A.
        • Kipen E.
        • Robertson V.J.
        • Bailey M.J.
        No rest for the wounded: early ambulation after hip surgery accelerates recovery.
        ANZ J Surg. 2006; 76 (JulPMID: 16813627): 607-611https://doi.org/10.1111/j.1445-2197.2006.03786.x
        • Sheehan K.J.
        • Goubar A.
        • Martin F.C.
        • Potter C.
        • Jones G.D.
        • Sackley C.
        • Ayis S.
        Discharge after hip fracture surgery in relation to mobilisation timing by patient characteristics: linked secondary analysis of the UK National Hip Fracture Database.
        BMC Geriatr. 2021; 21 (Dec 15PMID: 34911474; PMCID: PMC8672496): 694https://doi.org/10.1186/s12877-021-02624-w
        • Dinh M.M.
        • Russell S.B.
        • Bein K.J.
        • Vallmuur K.
        • Muscatello D.
        • Chalkley D.
        • Ivers R.
        Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: implications for major injury surveillance and trauma systems.
        Injury. 2017; 48 (JanEpub 2016 Aug 13. PMID: 27542554): 171-176https://doi.org/10.1016/j.injury.2016.08.005
        • Griffiths R.
        • Surendra Kumar D
        Major trauma in older people: implications for anaesthesia and intensive care medicine.
        Anaesthesia. 2017; 72 (NovEpub 2017 Aug 22. PMID: 28832941): 1302-1305https://doi.org/10.1111/anae.14027
        • Aw D.
        • Sahota O.
        Orthogeriatrics moving forward.
        Age Ageing. 2014; 43 (MayEpub 2014 Feb 20. PMID: 24556016): 301-305https://doi.org/10.1093/ageing/afu011
        • Murphy L.E.
        • McKenna S.M.
        • Shirley D.
        The best practice tariff and hip fractures: how can Northern Ireland keep up?.
        Surgeon. 2015; 13 (DecEpub 2014 Apr 13. PMID: 24726231): 308-311https://doi.org/10.1016/j.surge.2014.03.004