Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: a before-and-after study
Dinamarca-Montecinos, José Luis Vásquez Leiva, Alejandra Ruggiero, Carmelinda Fernández Barrera, Yasna Gac Delgado, Rayén Carrillo, Ada Améstica Lazcano, Gedeón Vásquez Ulloa, Daniel Aranda, Fernando Pizarro Canales, Andrés
Dinamarca-Montecinos, José Luis
Vásquez Leiva, Alejandra
Ruggiero, Carmelinda
Fernández Barrera, Yasna
Gac Delgado, Rayén
Carrillo, Ada
Améstica Lazcano, Gedeón
Vásquez Ulloa, Daniel
Aranda, Fernando
Pizarro Canales, Andrés
Abstract
Background: Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48-72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.
Objective: To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.
Design: Before-and-after study, between 01/01/2017-09/30/2019; 12 months before and 21 months after implementation.
Setting: Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.
Participants: Anonymised data of 902 hip-fractured older adults (≥ 60 years).
Intervention: Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.
Measurements: Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.
Results: After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).
Conclusion: Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.
MIDER Authors
Affiliations
University of Valparaíso; Dr. Gustavo Fricke Hospital; Andrés Bello University; University of Perugia; Fragility Fracture Network Italy; Viña del Mar-Quillota Health Service; Quilpué Hospital; Prince Charles Hospital; University of Queensland; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham
Date
2025-03-28
Type
Article
Collections
Citation
Dinamarca-Montecinos JL, Vásquez Leiva A, Ruggiero C, Fernández Barrera Y, Gac Delgado R, Carrillo A, Améstica Lazcano G, Vásquez Ulloa D, Aranda F, Pizarro Canales A, Mardones G, Gherardelli Morales C, Novik Assael V, Sepúlveda O, Acuña J, Aravena Arancibia C, Ibarra J, Bell J, Sutton E. Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study. J Frailty Aging. 2025 Jun;14(3):100014. doi: 10.1016/j.tjfa.2025.100014. Epub 2025 Mar 28.