Article

Treatment of hip fracture patients is controversial. We
implemented a new operative and supervision algorithm (the Hvidovre algorithm)
for surgical treatment of all hip fractures, primarily based on own previously
published results. METHODS: 2,000 consecutive patients over 50 years of age who
were admitted and operated on because of a hip fracture were prospectively
included. 1,000 of these patients were included after implementation of the
algorithm. Demographic parameters, hospital treatment, and reoperations within
the first postoperative year were assessed from patient records. RESULTS: 931 of
1,000 operative procedures were performed according to the algorithm, as compared
to only 726 of 1,000 prior to its introduction (p < 0.001). After implementation
of the algorithm, junior registrars still performed half of the operations, but
unsupervised procedures declined from 192 of 1,000 to 105 of 1,000 (p < 0.001).
The rate of reoperations declined from 18% to 12% (p < 0.001 in a multiple Cox
regression analysis), with a decline of 24% to 18% for intracapsular fractures
and a decline of 13% to 7% for extracapsular fractures. The proportion of
bed-days caused by reoperations was reduced from 24% of total hospitalization
before the algorithm was introduced to 18% after it was introduced.
INTERPRETATION: It is possible to implement an algorithm for treatment of all hip
fracture patients in a large teaching hospital. In our case, the Hvidovre
algorithm both raised the rate of supervision and reduced the rate of
reoperations. The reduced reoperation rate saved many hospital bed-days.

Langue : ANGLAIS