ACS NSQIP Hip Fracture Pilot. July 27, 2015

Transcription

1 ACS NSQIP Hip Fracture Pilot July 27, 2015

2 Project Update Joint effort between ACS and AAOS Pilot began on January 01, 2015 Pilot final operation date June 30, 2015 Variables collected through Hip Fracture custom group on ACS NSQIP Workstation Regular calls between participating sites, ACS Clinical Support, and AAOS

3 As of July 13, participating sites 1181 completed cases Lowest number of cases per site: 1 Highest number of cases per site: 99 Very low percentage of missing pilot data

4 Volume by CPT Code Code # of Cases

5 Patient Age Age at time of surgery Youngest Oldest Mean Median 82.17

6 Pre-operative dementia Pre-operative dementia Yes 28.79% No (no conclusive evidence) 70.96% Not answered 0.25%

7 Pre-operative delirium Pre-operative delirium Yes 12.19% No (no conclusive evidence) 86.54% Not answered 1.27%

8 Pre-fracture bone protection medication prescription Pre-fracture bone protection medication prescription Yes-oral only 20.32% Yes-intravenous only or both oral and intravenous 0.59% No evidence 78.58% Not answered 0.51%

9 Pre-operative mobility Pre-operative mobility Freely mobile without aids (no indication of limitations) 49.70% Mobile outdoors with one aid (cane or crutch), or equivalent 11.01% Mobile outdoors with Walker, or equivalent 18.20% Some indoor mobility but never goes outside without help, or equivalent 15.92% No functional mobility using lower limbs (wheelchair or bed bound) 4.32% Not answered 0.85%

10 Patient Age Age at time of surgery Youngest Oldest Mean Median 82.17

11 Patient Age Age at time of surgery Youngest Oldest Mean Median 82.17

12 Pre-operative pressure sore Pre-operative pressure sore Yes 3.30% No/cannot be determined 94.67% Not answered 2.03%

13 Medical co-management Medical co-management Yes-co-management throughout stay 67.91% Yes-partial co-management during stay 18.80% No 12.02% Not answered 1.27%

14 Standardized Hip Fracture Program Standardized hip fracture care program Yes-documented 46.82% No (no clear evidence/cannot be established) 49.96% Not answered 3.22%

15 WBAT on POD #1 Weight bearing as tolerated (WBAT) on POD #1 Yes-documented 59.70% No (cannot be determined) 24.64% N/A (bed-ridden or other medical issues) 14.64% Not answered 1.02%

16 Medical DVT prophylaxis 30 days post-op Medical DVT prophylaxis continued 30 days post-op Yes 53.51% No 37.68% Not answered 8.81%

17 Type/Location of fracture Type/location of fracture Femoral neck fracture (subcapital, Garden types 1 and 2)-undisplaced 10.00% Femoral neck fracture (subcapital, Garden Types 3 and 4)-displaced 28.62% Intertrochanteric 51.23% Subtrochanteric 6.94% Other/cannot be determined 3.13% Not answered 0.08%

18 Pathological fracture Pathological fracture Malignancy in bone 1.69% Benign lesion (Paget s disease, fibrous dysplasia, cyst, or other) in bone 0.25% Lesion in bone (cannot determine benign or malignant) 0.25% Atypical fracture (as primary diagnosis) 0.00% Septic fracture (infection of bone, osteomyelitis) 0.00% Medical condition/demineralization (excluding Osteoporosis) 1.36% No condition above is noted/cannot be determined 92.47% Not answered 3.98%

19 Post-operative pressure sore New post-operative pressure sore Yes (new location of pressure sore post-operatively) 4.83% No/cannot be determined 92.63% Not answered 2.54%

20 Post-operative delirium Post-operative delirium Yes 27.27% No (no conclusive evidence) 70.36% Not answered 2.37%

21 Post-operative mobility Post-operative mobility Freely mobile without aids 2.12% Mobile outdoors with one aid (cane or crutch) 5.67% Mobile outdoors with Walker 22.27% Some indoor mobility but never goes outside without help 35.82% No functional mobility using lower limbs (wheelchair or bed bound) 15.58% No mention of mobility status in records/cannot be determined 15.75% Not answered 2.79%

22 Prescription of post-op bone protection medication Prescription of post-op bone protection medication Yes-prescribed 30.48% No evidence 67.06% Not answered 2.46%

23 Place of residence at 30 days post-op Place of residence at 30 days post-op Skilled care 28.11% Unskilled facility 1.44% Facility which was home 9.57% Still in hospital 2.29% Home 37.09% Separate acute care 0.68% Expired 6.35% Unknown 9.82% Not answered 4.65%

24 National Hip Fracture Quality Initiatives Multiple stakeholders are actively engaged in quality initiatives to improve hip fracture care AOA (Own the Bone) AAOS OTA AJRR AAHKS ACS ABOS NBHA NOF

25 Adjournment Thank you!