Abstract
Introduction
In 2023, the average acute length of stay in the local hospital=23 days (national=16.0), 30-day mortality post hip fracture=6.6% (5.4%), prompt mobilisation=78% (81%) and return to original residence= 72% (74%). Nottingham Hip Fracture Score (NHFS) is most widely studied hip fracture risk stratification system especially in the UK, positively correlated with clinical frailty score (CFS), and is a simple tool to utilise on hip fracture admissions. High-risk identification distinguishes preoperative factors that are linked to clinical adverse outcomes after hip fracture surgery for patients, benefits those who need critical care admission, and provides appropriate informed consent.
Method
This is a retrospective service review of femoral fractures of a single centre in year 2023. 185 hip fracture cases were identified excluding 4 duplicates due to readmission. This only limits to pre-operative patient factors as per NHFS criteria, eGFR, falls and surgery characteristics and its clinical outcomes on mortality, mobility, length of stay (LOS), and discharge destination.
Results
68% hip fracture patients were scoring NHFS >=5. 33% were difficult to mobilise, 28% had acute LOS of 6-10 days, major primary causes of mortality were respiratory and cardiovascular issues, and sepsis, 23% were discharged to care homes. Patients with NHFS=6 (4.9%) died in 30 days, difficult to mobilise on day 1 (37%), and had acute LOS of 32 days, and discharged to care homes (41%). Mortality outcome does not reflect the literature evidence due to small sample size.
Conclusion
NHFS is an effective local hip fracture risk stratification tool. Based on the results and looking at further 6-month and 1-year outcomes: >=6 identifies high-risk mortality, difficulty mobilising or increased LOS, and discharge to care homes. It can improve local hip fracture service, help clinicians identify what matters most to hip fracture patient in the context of frailty and multi-morbidity, and serve patient’s best interests. eGFR, falls and surgery characteristics need further investigation.
Comments
Zolendronic acid prescription
This is a really interesting project! We have presented a project on IV zolendronic acid prescription following neck of femur fracture, with guidelines advising this is appropriate from day 7 onwards.
Your data on length of stay is really interesting - it suggests that in most cases we would have time to administer a bisphosphonate prior to discharge!
Thank you!
Regarding zoledronic, we have been using 5-day postop approach as long as vit D is repleted. The idea is to take the inpatient admission the opportunity to give the first dose and 60% of hip fracture patients receive it (unless contraindicated then alternative is being offered). I have seen a Trust giving it after 2 days postop if Vit D is okay. Otherwise, I have to bring our patient back to day treatment unit for the first dose if they have been discharged early.