股骨颈骨折术前处理回顾总结.pptVIP

Fractured neck of femur:an audit of pre-operative management Matthew Gwinnutt University of Birmingham Medical School Fractured neck of femur:an audit of pre-operative management In the UK: 70,000 hip fractures annually 120,000 cases per year by 2015 75% of patients are over 75 years of age 80% are female Average stay in hospital is 30 days 30-day mortality approximately 10% Hip fractures account for 20% all orthopaedic bed occupancy Fractured neck of femur:an audit of pre-operative management Scottish Intercollegiate Guidelines Network (SIGN): Assessment, within 1 hour of arrival in the Emergency Department (ED) Early diagnosis Adequate analgesia before transfer of the patient from the ED Rapid transfer to the ward - “fast tracking” Minimise the delay to definitive surgery A multidisciplinary team approach Postoperative care and rehabilitation Fractured neck of femur:an audit of pre-operative management Minimise the delay to definitive surgery Operate as soon as possible, within 24 hours of admission during daytime working hours, including weekends Medical conditions delaying surgery increase 30-day mortality by a factor of 2.5 Non-medical delays cause: Distress to the patient Increased morbidity and mortality Reduced chance of successful fixation and rehabilitation Reduced functional recovery Increased risk of DVT and PE Prolonged hospital stay Fractured neck of femur:an audit of pre-operative management Prospective audit, Oct 2007 – Feb 2008 All admissions to DGH with fractured neck of femur who underwent surgery Permission obtained from hospital Research and development department Data collected from clinical notes Admission and operation times Medical interventions performed pre-operatively Pre-op blood pressure, heart rate, urea Date of discharge In hospital mortality 3 month mortality Statistical evaluation of the effect of pre-operative variables on outcomes using t-test Fractured neck of femur:an audit of pre-operative management 66 patients