Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care

Abstract

ObjectiveTo compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.DesignRetrospective single-centre study.SettingUniversity hospital in middle Norway.Participants1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).Interventions788 patients were treated according to conventional care from April 2008 to September 2011, and 1032 patients were treated according to fast-track care from October 2011 to December 2013.Primary and secondary outcomePrimary: mortality and readmission to hospital, within 365 days follow-up. Secondary: length of stay.ResultsWe found no statistically significant differences in mortality and readmission rate between patients in the fast-track and conventional care models within 365 days after the initial hospital admission. The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment. Regarding the readmission, the conventional care group sub-HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates. Length of stay and time to surgery was statistically significant shorter for patients who received fast-track care, a mean difference of 3.4 days and 6 hours, respectively. There was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score at baseline between patients in the two pathways.ConclusionsThere was insufficient evidence to show an impact of fast-track care on mortality and readmission. Length of stay and time to surgery were decreased.Trial registration numberNCT00667914; results