Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Sep;12(Suppl 2):e002299.
doi: 10.1136/bmjoq-2023-002299.

Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic

Irewin A Tabu  1   2 , Karla Teresa S Araneta  3 , Bernardino B Alpuerto 2nd  4 , Giorgio D Delgado  4 , Joseph Garvy L Lai  4   5 , Jose Antonio G San Juan  6 , Alexander Ho Jr  6 , Ma Ramona B Reyes  7 , Jose De Vera  8 , Jose Fernando C Syquia  8 , Rene Edgardo C Manalastas  9 , Adrian Joseph C Tablante  10 , Allan Michael T Brabante  11 , Cesar Cipriano D Dimayuga  4   12 , Deejay M Pacheco  13 , Phillipe Y Baclig  14 , Andrew Steven T Co  14 , John Alfred D Yap  15 ; UPM-OFFM Associate Investigators and Fragility FIRST Philippines
Collaborators, Affiliations
Multicenter Study

Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic

Irewin A Tabu et al. BMJ Open Qual. 2023 Sep.

Abstract

Introduction: In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices.

Methods: A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined.

Results: 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031).

Conclusion: Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.

Keywords: COVID-19; Geriatrics; Hip Fractures; Surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Points of delay from injury to discharge.
See this image and copyright information in PMC

References

    1. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop 2019;10:166–75. 10.5312/wjo.v10.i3.166 - DOI - PMC - PubMed
    1. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018;8:13933. 10.1038/s41598-018-32098-7 - DOI - PMC - PubMed
    1. Guy DK, Bosco III JA, Savoie III FH. AAOS Guidelines on Elective Surgery During the COVID-19 Pandemic. The American Academy of Orthopaedic Surgeons, 2020.
    1. National Health Service (NHS) . Clinical Guide for Management of Trauma and Orthopedic Patients During the Corona Virus Pandemic. National Health Service (NHS), 2020.
    1. Trafton PG. Fragility fractures in the developing world: a rising challenge. Curr Geri Rep 2018;7:278–87. 10.1007/s13670-018-0267-8 - DOI

Publication types