No Change in Overall Mortality Rates Following A 60% Increase of Hip Fracture Surgeries Performed Within 48 Hours from Hospital Admission

Purpose: To evaluate the effect of regulatory measures aimed at promotion of early hip surgery (within 48 hours from admission) on rates of early surgery and on postoperative mortality.

Methods: Regulatory measures included additional reimbursement for afternoon operations (positive reinforcement) and making early operations’ rates publicly available as the Ministry of Health Quality Care Indexes (negative reinforcement). The rates of early surgery were compared with one-month and one-year mortality rates among three groups of patients with hip fractures treated in a single inner-city medical center during three time periods: 2006-2009 (n = 1735, no intervention), 2010-2013 (n = 2104, positive reinforcement) and 2014-2016 (n = 1538, positive and negative reinforcement).

Results: A total of 5377 patients (1595 males, 3782 females, mean age 83.1 ± 7.2 years) underwent hip surgery between 2006 and 2016. The three study groups did not differ significantly in age on admission, gender, type of hip fracture (intracapsular or extracapsular), ASA score, mean hemoglobin on admission and mean socioeconomic status. The percent of operations performed within 48 hours was 55%, 65% and 85%, respectively (p < 0.01). One-month mortality was 3.9%, 5.1% and 5% (p > 0.05), and one-year mortality was 19.2%, 18.7% and 19.6% (p > 0.05)

Conclusions: Management pressure on the staff to expedite hip surgery and avoid negative publicity in conjunction with additional reimbursement for afternoon surgeries was very successful at promoting earlier hip surgery. Despite the substantial increase in the rates of early surgery, however, mortality rates were not affected.