RESUMO
Introduction: The presence of a fragility fracture increases the risk of new fractures. The timely and prompt initiation of treatment for osteoporosis can reduce the incidence of new fractures, for which adherence to management is a determining factor. The main objective of the study was to characterize the secondary prevention program for fragility hip fractures in patients older than 65 years, determine adherence to treatment and its effect on the appearance of new fractures in the established follow-up period. Materials and Methods: A descriptive retrospective cohort study was carried out. Patients older than 65 years with a fragility hip fracture treated by an Orthogeriatric Clinical Care Center between May 2014 and April 2020 who completed a one-year follow-up were included. Results: A final sample of 290 patients was obtained (226 women and 64 men) with an average age of 82.27 years. It was found that 84.5% of patients received indications to start osteoporotic management prior to hospital discharge and only 35.2% started the treatment in the first 6 postoperative months. 16.6% (n = 48) of patients presented a new fracture, with no significant difference between those who started their osteoporosis treatment in a timely manner. Out of the 48 patients, 5 patients (10.4%) met therapeutic failure criteria. Discussion: Most patients (84.5%) received indications for starting osteoporotic treatment before hospital discharge, nevertheless 35.2% started it during the first 6 postoperative months. 16.6% of patients presented a new fracture during follow up, of which only five met therapeutic failure criteria. Conclusions: No significant differences were found between the presence of new fractures and early initiation of osteoporotic management. However, literature shows that prompt and timely osteoporotic treatment reduces the incidence of new fractures, thus measures must be implemented to strengthen the adherence and surveillance of patients to the indicated treatment.
RESUMO
BACKGROUND: Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement. METHODS: Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh. RESULTS: Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997-2001 and in 21% in 2003-2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002). CONCLUSION: Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.