Retrospective application of the performance indicator 'hip fracture: Operate within 24 hours' in 217 patients treated at the University Medical Centre Utrecht in 2000-2003: Reduction in postoperative pneumonia but not mortality

J. Pillay, J. C. Van Der Wouden, L. P H Leenen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective. To evaluate whether patients with hip fracture who undergo surgery within 24 hours - which has been propagated as an indicator of quality care - is associated with a reduced risk of mortality and complications, compared with later surgery. Design. Retrospective status study based on a prospectively designed electronic medical record. Method. Data were collected on patients aged ≥ 60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 1 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration of hospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. Results. A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. Conclusion. Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.

Translated title of the contributionRetrospective application of the performance indicator 'hip fracture: Operate within 24 hours' in 217 patients treated at the University Medical Centre Utrecht in 2000-2003: Reduction in postoperative pneumonia but not mortality
Original languageDutch
Pages (from-to)967-970
Number of pages4
JournalNederlands Tijdschrift voor Geneeskunde
Volume151
Issue number17
Publication statusPublished - 28 Apr 2007

Cite this

@article{3816d74456084ed2ad446e2719ff41c8,
title = "De prestatie-indicator 'heupfractuur: Opereren binnen 24 uur' retrospectief toegepast bij 217 pati{\"e}nten in het Universitair Medisch Centrum Utrecht, 2000-2003: Postoperatief minder vaak pneumonie, maar niet minder sterfte",
abstract = "Objective. To evaluate whether patients with hip fracture who undergo surgery within 24 hours - which has been propagated as an indicator of quality care - is associated with a reduced risk of mortality and complications, compared with later surgery. Design. Retrospective status study based on a prospectively designed electronic medical record. Method. Data were collected on patients aged ≥ 60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 1 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration of hospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. Results. A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75{\%} were female and 28{\%} were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82{\%} were female, and 49{\%} were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. Conclusion. Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.",
author = "J. Pillay and {Van Der Wouden}, {J. C.} and Leenen, {L. P H}",
year = "2007",
month = "4",
day = "28",
language = "Dutch",
volume = "151",
pages = "967--970",
journal = "Nederlands Tijdschrift voor Geneeskunde",
issn = "0028-2162",
publisher = "Bohn Stafleu van Loghum",
number = "17",

}

TY - JOUR

T1 - De prestatie-indicator 'heupfractuur

T2 - Opereren binnen 24 uur' retrospectief toegepast bij 217 patiënten in het Universitair Medisch Centrum Utrecht, 2000-2003: Postoperatief minder vaak pneumonie, maar niet minder sterfte

AU - Pillay, J.

AU - Van Der Wouden, J. C.

AU - Leenen, L. P H

PY - 2007/4/28

Y1 - 2007/4/28

N2 - Objective. To evaluate whether patients with hip fracture who undergo surgery within 24 hours - which has been propagated as an indicator of quality care - is associated with a reduced risk of mortality and complications, compared with later surgery. Design. Retrospective status study based on a prospectively designed electronic medical record. Method. Data were collected on patients aged ≥ 60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 1 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration of hospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. Results. A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. Conclusion. Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.

AB - Objective. To evaluate whether patients with hip fracture who undergo surgery within 24 hours - which has been propagated as an indicator of quality care - is associated with a reduced risk of mortality and complications, compared with later surgery. Design. Retrospective status study based on a prospectively designed electronic medical record. Method. Data were collected on patients aged ≥ 60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 1 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration of hospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. Results. A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. Conclusion. Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.

UR - http://www.scopus.com/inward/record.url?scp=34248334993&partnerID=8YFLogxK

M3 - Article

VL - 151

SP - 967

EP - 970

JO - Nederlands Tijdschrift voor Geneeskunde

JF - Nederlands Tijdschrift voor Geneeskunde

SN - 0028-2162

IS - 17

ER -