Title: Audit on the Impact of Theatre Time Available on Time to Surgery for Hip Fracture Patients.

Biography:

Works at Ealing Hospital
 

Abstract

Hip fractures are a major public health problem. In United Kingdom 76,000 people are hospitalised with hip fractures every year [1]. Mortality is high, 6.2% mortality in first 30 days in UK [2] and 22% mortality rate during the first year globally. [3] Delaying surgery is associated with increased mortality and morbidity and surgery performed on the day of or after admission (or within 36 hours) is associated with improved outcome [4,5]. NICE recommends that the surgery should be performed on the day of or the day after admission for better pain control, earlier mobilisation, improved morbidity and likely reduced mortality [6] and BPT recommends that the fracture should be operated within 36 hours [7]. Several factors can result in inappropriate delay to surgery like lack of available theatre space, administrative delays, medical reasons etc. We are doing this audit to find the compliance of our hospital to NICE/BPT guidelines and to measure if increase in theatre availability had any impact on improving our time to surgery and whether we need more theatre time in future,
Standards/ Guidelines
We compared our management against these 2 standards for surgical management of hip fractures:

1. NICE Guidelines which says that patient with hip fracture needs to be operated on the day of the injury or the next day.
2. Best Practice Tariff (BPT) Guidelines say that the patients with hip fractures should be operated within 36 hours of injury.

Compliance of 75% will be considered as adequate and compliance of 90% will be considered excellent.

Our hospital is a busy mixed speciality hospital. There is an active orthopaedic and trauma service. We have only one theatre for trauma surgeries that is shared between Orthopaedic and general surgery. Our hospital provided T&O department one theatre for half a day on 5 weekdays i.e 5 theatre sessions. However, from 05 Feb 2018, we were provided 2 full day theatres on Monday and Friday and 3 half day theatres on rest of weekdays i.e 7 theatre sessions. We also operated hip fractures on the weekend in both periods again sharing the theatre with general surgery. In this cohort study we took 103 hip fracture patients (100 operated and 3 managed nonoperatively) who were treated before and 106 fracture patients (100 operated and 6 managed non-operatively) treated after 5 Feb 2018. These patients were admitted between 21-08-2017 and 13-10-2018. We gathered data regarding Date of admission, time of admission, date and time of start of anaesthesia, survival in the first year, and we used this to calculate the time in days from admission to anaesthesia and time in hours from admission to anaesthesia in both the groups. We also gathered data regarding the reason of delay in both time periods. We also compared the mortality in the two groups. We used T-Test to calculate the significance of the average time to surgery in these periods and we used chi-square test to calculate the significance of other observations.