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1. IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit

Author

Andrew J. Hall, Nicholas D. Clement, Cristina Ojeda-Thies, Alasdair MJ. MacLullich, Giuseppe Toro, Antony Johansen, Tim O. White, Andrew D. Duckworth, Hani Abdul-Jabar, Rashid Abu-Rajab, Ahmed Abugarja, Karen Adam, Héctor J. Aguado Hernández, Gedeón Améstica Lazcano, Sarah Anderson, Mahmood Ansar, Jonathan Antrobus, Esteban Javier Aragón Achig, Maheswaran Archunan, Mirentxu Arrieta Salinas, Sarah Ashford–Wilson, Cristina Assens Gibert, Katerina Athanasopoulou, Mohamed Awadelkarim, Stuart Baird, Stefan Bajada, Shobana Balakrishnan, Sathishkumar Balasubramanian, James A. Ballantyne, Leopoldo Bárcena Goitiandia, Benjamin Barkham, Christina Barmpagianni, Mariano Barres-Carsi, Sarah Barrett, Dinnish Baskaran, Jean Bell, Katrina Bell, Stuart Bell, Giuseppe Bellelli, Javier Alberto Benchimol, Bruno Rafael Boietti, Sally Boswell, Adriano Braile, Caitlin Brennan, Louise Brent, Ben Brooke, Gaetano Bruno, Abdus Burahee, Shirley Burns, Giampiero Calabrò, Lucy Campbell, Guido Sebastian Carabelli, Carol Carnegie, Guillermo Carretero Cristobal, Ethan Caruana, M.a Concepción Cassinello Ogea, Juan Castellanos Robles, Pablo Castillon, Anil Chakrabarti, Antonio Benedetto Cecere, Ping Chen, Jon V. Clarke, Grace Collins, Jorge E. Corrales Cardenal, Maurizio Corsi, Gara María Cózar Adelantado, Simon Craxford, Melissa Crooks, Javier Cuarental-García, Rory Cuthbert, Graham Dall, Ioannis Daskalakis, Annalisa De Cicco, Diana de la Fuente de Dios, Pablo Demaria, John Dereix, Julian Díaz Jiménez, José Luis Dinamarca Montecinos, Ha Phuong Do Le, Juan Pablo Donoso Coppa, Georgios Drosos, Andrew Duffy, Jamie East, Deborah Eastwood, Hassan Elbahari, Carmen Elias de Molins Peña, Mamoun Elmamoun, Ben Emmerson, Daniel Escobar Sánchez, Martina Faimali, Maria Victòria Farré-Mercadé, Luke Farrow, Almari Fayez, Adam Fell, Christopher Fenner, David Ferguson, Louise Finlayson, Aldo Flores Gómez, Nicholas Freeman, Jonathan French, Santiago Gabardo Calvo, Nicola Gagliardo, Joan Garcia Albiñana, Guillermo García Cruz, Unai García de Cortázar Antolín, Virginia García Virto, Sophie Gealy, Sandra Marcela Gil Caballero, Moneet Gill, María Soledad González González, Rajesh Gopireddy, Diane Guntley, Binay Gurung, Guadalupe Guzmán Rosales, Nedaa Haddad, Mahum Hafeez, Petra Haller, Emer Halligan, John Hardie, Imogen Hawker, Amr Helal, Mariana Herrera Cruz, Ruben Herreros Ruiz-Valdepeñas, James Horton, Sean Howells, Alan Howieson, Luke Hughes, Flavia Lorena Hünicken Torrez, Ana Hurtado Ortega, Peter Huxley, Hytham K.S. Hamid, Nida Ilahi, Alexis Iliadis, Dominic Inman, Piyush Jadhao, Rajan Jandoo, Lucy Jawad, Malwattage Lara Tania Jayatilaka, Paul J. Jenkins, Rathan Jeyapalan, David Johnson, Andrew Johnston, Sarah Joseph, Siddhant Kapoor, Georgios Karagiannidis, Krishna Saga Karanam, Freddy Kattakayam, Alastair Konarski, Georgios Kontakis, Gregorio Labrador Hernández, Victoria Lancaster, Giovanni Landi, Brian Le, Ignatius Liew, Kartik Logishetty, Andrew Carlomaria Daniel Lopez Marquez, Judit Lopez, Joann Lum, Gavin J. Macpherson, Suvira Madan, Sabreena Mahroof, Khalid Malik-Tabassum, Ravi Mallina, Afnan Maqsood, Ben Marson, M. José Martin Legorburo, Encarna Martin-Perez, Tania Martínez Jiménez, Javier Martinez Martin, Alistair Mayne, Amy Mayor, Gavan McAlinden, Lucille McLean, Lorna McDonald, Joshua McIntyre, Pamela McKay, Greg McKean, Heather McShane, Antonio Medici, Chelsea Meeke, Evonne Meldrum, Mijail Mendez, Scott Mercer, Josu Merino Perez, María-Pilar Mesa-Lampré, Shuna Mighton, Kirsty Milne, Muhammed Mohamed Yaseen, Iain Moppett, Jesus Mora, Sira Morales-Zumel, Irene Blanca Moreno Fenoll, Adham Mousa, Alastair W. Murray, Elspeth V. Murray, Radhika Nair, Fiona Neary, Giacomo Negri, Oliver Negus, Fiona Newham-Harvey, Nigel Ng, Jess Nightingale, Sumiya Noor Mohamed Anver, Perrico Nunag, Matthew O'Hare, Ben Ollivere, Raquel Ortés Gómez, AnneMarie Owens, Siobhan Page, Valentina Palloni, Andreas Panagiotopoulos, Elias Panagiotopoulos, Paul Panesar, Antonios Papadopoulos, Papagiannis Spyridon, Teresa Pareja Sierra, Chang Park, Hammad Parwaiz, Paul Paterson-Byrne, Sam Patton, Jack Pearce, Marina Porter, Achille Pellegrino, Arturo Pèrez Cuellar, Raffaele Pezzella, Ashish Phadnis, Charlotte Pinder, Danielle Piper, Matilda Powell-Bowns, Rocío Prieto Martín, Annabel Probert, Ashwanth Ramesh, Manuel Vicente Mejía Ramírez de Arellano, Duncan Renton, Stephen Rickman, Alastair Robertson, Adrian Roche Albero, José Alberto Rodrigo Verguizas, Myriam Rodríguez Couso, Joanna Rooney, Pilar Sáez-López, Andres Saldaña-Díaz, Adriano Santulli, Marta Isabel Sanz Pérez, Khaled M. Sarraf, Christine Scarsbrook, Chloe E.H. Scott, Jennifer Scott, Sachi Shah, Sharief Sharaf, Sidharth Sharma, Denise Shirley, Antonio Siano, James Simpson, Abhinav Singh, Amit Singh, Tim Sinnett, Gurudatt Sisodia, Philomena Smith, Eugenia Sophena Bert, Michael Steel, Avril Stewart, Claire Stewart, Kapil Sugand, Niall Sullivan, Lauren Sweeting, Michael Symes, Dylan Jun Hao Tan, Francesco Tancredi, Irini Tatani, Philip Thomas, Fraser Thomson, Niamh S. Toner, Anna Tong, Antonio Toro, Theodoros Tosounidis, Stylianos Tottas, Andrea Trinidad Leo, Damien Tucker, Krishna Vemulapalli, Diego Ventura Garces, Olivia Katherine Vernon, Juan Carlos Viveros Garcia, Alex Ward, Kirsty Ward, Kate Watson, Thisara Weerasuriya, Udara Wickramanayake, Hannah Wilkinson, Joseph Windley, Janet Wood, William Wynell-Mayow, Giovanni Zatti, Moez Zeiton, and Miriam Zurrón Lobato

Subjects
Surgery
Published
2022
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2. Reducing delays to surgery and achieving best practice tariff for hip fracture patients on direct oral anticoagulants: A protocol for expediting surgery without increasing peri-operative complications

Author

Amy Mayor, Ben Brooke, and John Stephenson

Subjects
Emergency Medicine, Surgery, Critical Care and Intensive Care Medicine
Abstract

Background Patients who sustain a hip fracture whilst taking direct oral anticoagulants (DOACs) experience delays to surgery, which can increase morbidity and mortality. Achievement of the prompt surgery aspect of the National Hip Fracture Database (NHFD) best practice tariff (BPT) stipulates surgery within 36 h, which these patients often fail to meet. Patients and methods Our protocol for expedited hip fracture surgery in patients taking DOACs was implemented. We compared surgery within 36 h (primary outcome) and peri-operative blood transfusions, 30-day mortality, wound leakage, return to theatre and length of hospital stay (secondary outcomes) with standard care of 80 matched non-anticoagulated controls. Results Median times to theatre were 26.0 h (IQR 16.2 h) in DOAC patients and 22.4 h (IQR 16.9 h) in controls: bootstrapped 95% CI for the difference (−0.935, 7.52). Bias-corrected related samples bootstrapped t-test revealed no evidence for a group difference on the primary outcome ( p = 0.133) or any secondary outcome, including post-operative transfusions (χ2(1) = 0.533; p = 0.465, 95% CI for the difference −18.3% to 8.37%); death within 30 days (χ2(1) = 0.667; p = 0.414, 95% CI for the difference −3.48% to 8.48%); wound leakage (χ2(1) = 0.571; p = 0.450, 95% CI −1.79% to 0.792%); return to theatre (χ2(1) = 0.00; p = 1.00); and median length of hospital stay ( p = 0.678, bias-corrected bootstrapped 95% CI for the difference −4.47 to 6.68). Discussion Our protocol is simple, does not require plasma DOAC level testing and can be used to achieve the NHFD recommendation of surgery within 36 h without increasing peri-operative transfusions, wound leakage, return to theatre, length of stay or mortality.

Published
2023
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3. Pre-operative Medical Assessment and Optimisation

Author

Helen Wilson and Amy Mayor

Subjects
medicine.medical_specialty, Hip fracture, Fragility fracture, business.industry, General surgery, medicine, MEDLINE, Daily living, Medical assessment, business, medicine.disease, Pre operative
Abstract

One-third of patients presenting with hip fracture are active and independent without significant comorbidities that impact on their daily living. For them, the risk of surgery and post-operative complications is low. However, the challenge arises for those with markers of frailty, and it is important to consider that a quarter of patients are likely to be in their last year of life.

Published
2020
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