Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN).
ABSTRACT This study was designed to estimate trends in the number of proximal femoral fractures (PFFs), and consequent bed day requirements and financial implications for England until 2033.
Trends in the number of coded PFFs from 1998 to 2008 (collected from Hospital Episode Statistics Online) were projected forward to 2033, and modified according to published data concerning population demographics and declining PFF prevalence. Estimates of 30 day postoperative mortality were calculated according to projected demographic data. Financial estimates were calculated according to current cost and adjusted according to projected inflation.
Despite a decline in the prevalence of PFF among the aging population (2.98% since 2002), we estimate that approximately 100,000 patients annually will require surgery for fractured neck of femur by 2033 in England, with a 30d mortality of 8.9-9.3%, costing £3.6-5.6 billion (inflation adjusted) in total care.
The evaluation and implementation of cost-effective preventive and therapeutic strategies in the short term may help to ameliorate the future financial burden of PFF, and, more importantly, improve the outcome and quality of life for the elderly after fracture.
Article: The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures.[show abstract] [hide abstract]
ABSTRACT: Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified 'poor consent' as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p = 0.0001). This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using preprinted consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.Annals of The Royal College of Surgeons of England 07/2012; 94(5):308-12. · 1.23 Impact Factor
Article: The use of LiDCO based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: neck of femur optimisation therapy - targeted stroke volume (NOTTS): study protocol for a randomized controlled trial.[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days). Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis) has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery. METHODS: Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables. Setting: University hospital in UK. Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years. Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus). Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume. Control group: fluid administration at the responsible (blinded) anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion. Primary outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073. TRIAL REGISTRATION NUMBER: Trial registration: Current Controlled Trials ISRCTN88284896.Trials 09/2011; 12:213. · 2.02 Impact Factor