16ASSESSING THE IMPACT OF SATURDAY TRAUMA OPERATING LISTS ON THE TIME TO SURGERY FOR PATIENTS WITH FRACTURED NECK OF FEMUR

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Abstract

Introduction: Neck of femur fracture is common in the elderly population and is associated with high mortality, morbidity and healthcare cost. Delay to surgery is known to adversely affect outcome. Croydon University Hospital, South London, serves a population of 360,000 and has an Orthogeriatrican providing joint care for hip fracture patients over 60 years on a dedicated ward. In 2011 the Saturday trauma operating list was discontinued, leading to all weekend trauma cases subsequently being placed on the CEPOD list. In July 2012 the Saturday Trauma list was re-introduced.

Aim: To perform a retrospective interrogation of the database of patients with neck of femur fracture and assess the impact of Saturday trauma lists on time to surgery and mortality.

Method: Data were analysed retrospectively from the National Hip Fracture Database for all patients aged 60 years and over admitted and operated on with a fractured neck of femur for 2012.

Results: 260 patients were admitted over the audit period.

Post introduction of the Saturday list:

• Reduction in mean time to surgery 48.8 hours to 36.7 hours (p = 0.05)

• Increase in the percentage of patients proceeding to surgery under 36 hours from 51.5% to 72% p = <0.05)

• Non significant reduction in the average length of stay from 26.8 days to 23.6(p = 0.17).

• Non significant reduction in mortality 14.6% compared to 12.1% (p = 0.56).

• No significant change in mean time to assessment by an Orthogeriatrician 40.5 hrs to 41.5 (p = 0.87).

Conclusions: Introduction of the Saturday trauma list has shown a reduction in time to surgery, with an increased number of patients receiving surgery within 36 hours and reduction in length of stay. This supports the continuation of the Saturday trauma list as part of a strategy to improve patient care and compliance with hip fracture guidelines.

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