Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients

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Abstract

Background and purpose — Following a hip fracture, most patients will encounter poorer functional outcomes and an increased risk of death. Treatment-monitoring of hip fracture patients is in many countries done by national audits. However, they do not allow for a deeper understanding of treatment limitations. We performed a local evaluation study to investigate adherence to 7 best-practice indicators, and to investigate patient groups at risk of suboptimal treatment. Patients and methods — 2,804 patients were surgically treated for a hip fracture from 2011 to 2017 at our institution. Data regarding admission, hospital stay, and discharge was prospectively collected, and adherence to the 7 best practice indicators (nerve block, surgical delay, antibiotics, implant choice, thromboprophylaxis, mobilization, and blood transfusions) was analyzed. Patient groups with lower adherence were identified. Results — 34% of patients received all 7 best practice indicators after considering contraindications; in particular, nerve blocks and thromboprophylaxis displayed low adherence at 61% and 91% respectively. Nursing home residents and patients with cognitive impairment, multiple comorbidities, or low functional levels were at risk of having a lower adherence. Interpretation — The most dependent patients with cognitive impairment, comorbidities, or low functional levels had lower guideline adherence. This large patient subgroup needs a higher treatment focus and more resources. Our findings are likely similar to those in other national and international institutions.

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Frandsen, C. F., Glassou, E. N., Stilling, M., & Hansen, T. B. (2021). Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients. Acta Orthopaedica, 92(5), 544–550. https://doi.org/10.1080/17453674.2021.1925430

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