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. 2021 Oct;19(5):e298-e303.
doi: 10.1016/j.surge.2021.01.003. Epub 2021 Feb 1.

Effect of Covid-19 on best practice care of hip fracture patients: An analysis from the National Hip Fracture Database (NHFD)

Ben Tyas  1 , Mike Wilkinson  2 , Kiran Singisetti  3
Affiliations

Effect of Covid-19 on best practice care of hip fracture patients: An analysis from the National Hip Fracture Database (NHFD)

Ben Tyas et al. Surgeon. 2021 Oct.

Abstract

Background: Best practice tariff (BPT) has brought significant improvements in hip fracture care; the 2019 report showing a 30-day mortality of 6.1%. Data relating to more than 65,000 patients who sustain a fractured neck of femur (FNOF) are recorded each year in the National Hip Fracture Database (NHFD). The aim of our study was to review the impact of COVID-19 on BPT.

Methods: Data was extracted from the NHFD for England, Wales and Northern Ireland. The months of March to June 2020 (lockdown period related to COVID-19) were compared to the same period in 2019. Data used in this study was collated and analysed between 14th and 17th October 2020.

Results: Data for more than 40,000 patients was reviewed. BPT dropped -4.3% in March, -12.6% in April, -12.9% in May 2020, and -7.2% in June. Prompt surgery remained stable (four-month average + 0.1%). The most significant changes were noted for timely orthogeriatric review (-7.6%, p < 0.001), bone health assessment (-7.3%, p < 0.001) and post-operative delirium assessment (-6.6%, p < 0.001). 30-day mortality increased to 13.7% in March 2020 and remained high in April 2020 (11.3%) and May (7.3%). Acute hospital length of stay was lowest in May 2020 (11.7 days).

Conclusion: Patients sustaining FNOF in March 2020 had an associated 30-day mortality of 13.7%. During the COVID-19 pandemic, there was a significant reduction in BPT. The most significant changes were observed in timely orthogeriatric review. Maintaining a high standard of multidisciplinary care for this vulnerable group of patients is crucial during future spikes of COVID-19.

Keywords: Best practice tariff; Coronavirus; Covid-19; Hip fracture; NHFD.

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Figures

Fig. 1
Fig. 1
Comparative 30-day mortality rates (%) by month of admission.
Fig. 2
Fig. 2
Comparative acute hospital length of stay (days) and number of patients discharged by month of discharge.
See this image and copyright information in PMC

References

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