Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data
| العنوان: | Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data |
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| المؤلفون: | Kaspar Tootsi, Helgi Kolk, Toomas Saluse, Pärt Prommik, Aare Märtson |
| المصدر: | Archives of Osteoporosis. 16 |
| بيانات النشر: | Springer Science and Business Media LLC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | 0301 basic medicine, Hip fracture, medicine.medical_specialty, education.field_of_study, business.industry, General surgery, Population, 030209 endocrinology & metabolism, Patient survival, Retrospective cohort study, medicine.disease, Occult, 03 medical and health sciences, 0302 clinical medicine, Orthopedic surgery, medicine, Orthopedics and Sports Medicine, 030101 anatomy & morphology, Nonoperative management, business, education, Management practices |
| الوصف: | A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option. Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients’ survival compared with those treated with operative management (OM). This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically. From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient’s refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%). Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM’s superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question — well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk. |
| تدمد: | 1862-3514 1862-3522 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::66dc265d071c29bf932d420f9c5089e9 https://doi.org/10.1007/s11657-021-00973-y |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi...........66dc265d071c29bf932d420f9c5089e9 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 18623514 18623522 |
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