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Hip fractures in Spain: are we on the right track? Statistically significant differences in hip fracture management between Autonomous Communities in Spain

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Abstract

Summary

Although medicine is currently protocol-based, there are still differences in the management of the hip fracture in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations. This data will be of great value to assist stakeholders in formulating health policies.

Purpose

Analysis of demographic, clinical, surgical, and functional data of the Spanish National Hip Fracture National Registry (RNFC), during admission and at 1-month follow-up, by Autonomous Communities (ACs).

Methods

Cross-sectional analysis in the framework of a RNFC cohort, from January 2017 to May 2018, including 15 ACs from Spain, with 1 month of follow-up. Sociodemographic, clinical, surgical, and outcome variables were analyzed.

Results

In total, 13,839 patients were analyzed. There were significant differences (p <0.001) in median surgical delay and percentage of patients operated in less than 48 h. Mean surgical delay was 70.75 h, with a 12-h difference between the Communities of Madrid (71.22) and Catalonia (59.65). Only 43% of patients had less than 48-h delay. Overall, most patients received regional anesthesia (91.9%); however, there was a significant difference between ACs (p = 0.0001). There were also differences in inpatient stay, early mobilization, discharge destination, and mortality (p <0.001). Mortality 30 days after surgery was 7.8%, and highest in the Basque Country (12.5%).

Conclusions

The registry showed homogeneity among ACs regarding sociodemographic variables, fracture type, surgical treatment, ASA risk, and co-management with a geriatrician or an integrated internist. There were significant differences in hip fracture management between ACs in Spain, especially regarding surgical delay, type of anesthesia, early mobilization, and discharge destinations.

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Authors and Affiliations

  1. Department of Traumatology and Orthopaedic Surgery, University Hospital of Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain

    Pablo Castillón, Jorge H. Nuñez, Jordi Salvador & Francesc Anglés

  2. Departament de Cirurgia Universitat de Barcelona, Barcelona, Spain

    Francesc Anglés

  3. Department of Traumatology and Orthopaedic Surgery, University Hospital of Vall d’ Hebron, Passeig de la Vall d’Hebron, 119, 08035, Barcelona, Spain

    Jorge H. Nuñez

  4. Complexo Hospitalario Universitario de Ourense, Calle Ramón Puga Noguerol, 54, 32005, Ourense, Spain

    Fatima Mori-Gamarra

  5. Department of Traumatology and Orthopaedic Surgery, University Hospital of 12 de Octubre, Av. Córdoba s/n, 28041, Madrid, Spain

    Cristina Ojeda-Thies

  6. Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain

    Pilar Sáez-López & Juan Ignacio González-Montalvo

  7. Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Pilar Sáez-López

  8. Spanish National Hip Fracture Registry, Madrid, Spain

    Pilar Sáez-López

  9. Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Juan Ignacio González-Montalvo

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  1. Pablo Castillón
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Castillón, P., Nuñez, J.H., Mori-Gamarra, F. et al. Hip fractures in Spain: are we on the right track? Statistically significant differences in hip fracture management between Autonomous Communities in Spain. Arch Osteoporos 16, 40 (2021). https://doi.org/10.1007/s11657-021-00906-9

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