המכון הלאומי לחקר שרותי הבריאות ומדיניות הבריאות (ע”ר)

The Israel National Institute For Health Policy Research

Hip fracture patients: What is the breakeven between early surgery and increasing patient mortality? The risk of non-exhaustive quality measures

Researchers: Kobi Peleg1,2, Avi Israeli3,4
  1. Gertner Institute
  2. Tel Aviv University
  3. Hadassah Medical Center
  4. MInistry of Health
Background: Many studies have proven the benefit of earlier hip fracture surgery. For a long time, the State of Israel is trying to increase the proportion of earlier hip fracture surgeries in hospitals in order to improve patient survival.
Objectives: 1. To analyze the relation between risk factors in previous co-morbidity and medication intake to mortality after earlier hip fracture surgeries.
2. To find the break-even point between the proportion of surgeries in the first 48 hours of hospitalization and the point beyond which the mortality may rise.
Method: A retrospective study based on patients aged 65 and above with an isolated hip fracture following trauma who were hospitalized in the years 2000-2016. The registry data on surgeries was crossed with comorbidity and medication intake data from Clalit Medical Fund. Trend analysis, mediation analysis and GEE logistic models were employed to establish the relationships between earlier surgery, comorbidity, year of hospitalization, operating hospital, as well as patients` age and sex on in-hospital and one-year mortality.
Findings: Earlier surgery was beneficial for all categories of patients, including those with comorbidities. The 2014 mortality spike took place only among patients aged 85+ and was independent of clinical factors. No break-even boundary where mortality grows accordingly to growth in proportion in earlier surgeries was found.
Conclusions: 1. Earlier surgery improves survival in all groups of patients, including those with comorbidities and patients on prescription medicine.
2. The introduction of quality parameters led to increased uniformity between hospitals and ultimately – to better outcomes. On the other hand’ it seems that in such processes, the system needs time to adjust and learn (year 2014).
Recommendations: Earlier hip fracture surgery is justified in suitable cases, however, a “learning period” of temporarily decreased outcomes should be taken into account when designing quality measures.
Research number: A/13/2016
Research end date: 08/2019