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Scientific Articles   |    
Patient Risk Factors, Operative Care, and Outcomes Among Older Community-Dwelling Male Veterans with Hip Fracture
Tiffany A. Radcliff, PhD1; William G. Henderson, PhD2; Tamara J. Stoner, MD3; Shukri F. Khuri, MD4; Michael Dohm, MD5; Evelyn Hutt, MD1
1 Colorado REAP to Improve Care Coordination, VA Eastern Colorado Health Care System, 1055 Clermont Street (MS 151), Denver, CO 80220. E-mail address for T.A. Radcliff: Tiffany.Radcliff@uchsc.edu
2 Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, 12477 East 19th Avenue, Building 406, Aurora, CO 80045
3 Department of Anesthesiology, University of Colorado at Denver and Health Sciences Center, 4200 East 9th Ave (B113), Denver, CO 80262
4 Brockton/West Roxbury VA Medical Center, Roxbury Massachusetts, 940 Belmont Street (MS 112/NSQIP), Brockton, MA 02301
5 Western Slope Study Group, 2356 North 7th Street, Grand Junction, CO 81501-8101
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of more than $10,000 from the Department of Veteran Affairs. (Financial and salary support for Drs. Radcliff and Hutt was provided by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service via the Targeted Research Enhancement Program (TREP) to Improve the Quality of Life and Care to Veterans in Long-term Care, Denver Veterans Administration Medical Center. Collection of the National Surgical Quality Improvement Program data is supported by the Office of Patient Care Services, Department of Veterans Affairs Central Office, Washington, D.C.) Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Investigation performed at the Denver VA Medical Center, Denver, Colorado

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jan 01;90(1):34-42. doi: 10.2106/JBJS.G.00065
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Abstract

Background: Although more than 1200 hip fracture repairs are performed in United States Department of Veterans Affairs hospitals annually, little is known about the relationship between perioperative care and short-term outcomes for veterans with hip fracture. The purpose of the present study was to test whether perioperative care impacts thirty-day outcomes, with patient characteristics being taken into account.

Methods: A national sample of 5683 community-dwelling male veterans with an age of sixty-five years or older who had been hospitalized for the operative treatment of a hip fracture at one of 108 Veterans Administration hospitals between 1998 and 2003 was identified from the National Surgical Quality Improvement Program data set. Operative care characteristics were assessed in relation to thirty-day outcomes (mortality, complications, and readmission to a Veterans Administration facility for inpatient care).

Results: A surgical delay of four days or more after admission was associated with a higher adjusted mortality risk (odds ratio, 1.29; 95% confidence interval, 1.02 to 1.61) but a reduced risk of readmission (odds ratio, 0.70; 95% confidence interval, 0.54 to 0.91). Compared with spinal or epidural anesthesia, general anesthesia was related to a significantly higher risk of both mortality (odds ratio, 1.27; 95% confidence interval, 1.01 to 1.55) and complications (odds ratio, 1.33; 95% confidence interval, 1.15 to 1.53). The type of procedure was not significantly associated with outcome after controlling for other variables in the model. However, a higher American Society of Anesthesiologists Physical Status Classification (ASA class) was associated with worse thirty-day outcomes.

Conclusions: In addition to recognizing the importance of patient-related factors, we identified operative factors that were related to thirty-day surgical outcomes. It will be important to investigate whether modifying operative factors, such as reducing surgical delays to less than four days, can directly improve the outcomes of hip fracture repair.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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