Introducing the "hip call" to facilitate early surgical treatment of hip fractures: A feasibility study.

INTRODUCTION: Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far. The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for pre-operative preparation and surgery compared to a historical control cohort. MATERIALS AND METHODS: From March 4, 2019 until June 30, 2019, admission of patients at Copenhagen University Hospital, Bispebjerg, Denmark, with a suspected hip fracture triggered an acute hip call. Key personnel are summoned to secure rapid pre-operative preparation and surgery. The implementation was defined feasible, if ≥ 75% of the patients were ready for surgery within 4 hours and had surgery initiated within 24 hours of hospital arrival. The historical control cohort was patients with hip fractures in the same period in 2018. RESULTS: A total of 128 patients were included in 2019, and 99 in 2018. After implementation of hip call, 83% of patients were ready for surgery within 4 hours. After vs before hip call, 88% vs 51% were operated within 24 hours and 96% vs 79% within 36 hours. Time from admission to surgery (hh:mm) was reduced by mean 10:33 (CI 07:46-13:20), P < .001. CONCLUSION: The implementation of a hip call was feasible with 83% of patients being ready for surgery within 4 hours, and 88% being operated within 24 hours. Future large-scale studies should clarify potential benefits on clinical outcome.

Inadequate emergence after non-cardiac surgery-A prospective observational study in 1000 patients.

INTRODUCTION: The post-anaesthetic phase is most often uncomplicated, but patients may experience inadequate emergence (IE) characterized by unrest, restlessness, aggressiveness or in contrast sedation or lack of initiative. This may increase length of stay (LOS) and post-operative complications. The aim of this study was to investigate frequency, risk factors and consequences of IE. METHODS: We conducted an observational cohort study including 1000 orthopaedic and abdominal surgical patients, screened with the Nursing Delirium Screening Scale (Nu-DESC) before induction of anaesthesia, at arrival at the post-operative care unit, and just before discharge from PACU. IE was defined as a Nu-DESC score ≥2 after surgery. Predictors included surgical procedure, type and duration of anaesthesia, age, ASA-score, sex and post-operative pain. Data were analysed during adjusted logistic regression and Wilcoxon rank sum test, the primary outcome being LOS. RESULTS: IE occurred in 103 of 1000 patients (10.3%, 95% CI 8.6-12.3%). LOS was median 2 vs 1 day in patients with and without IE, mean difference was 1.3 (SD 6.2) days (P = 0.036). Thirty-day mortality was 2.9 vs 1.0% (P = 0.92) and admission to ICU 1.0 vs 0.9% (P = 0.66) in patients with and without IE. Significant associations to IE were found for inhalational anaesthetics (OR 2.65; 95% CI: 1.57-4.46), duration of anaesthesia ≥2 hours (OR 1.98; 95% CI: 1.14-3.44) and ASA-score ≥3 (OR 2.74; 95% CI: 1.64-4.57). CONCLUSION: One of 10 patients had IE as defined by the Nu-DESC score, which was significantly associated with increased LOS. Longer duration of anaesthesia, inhalational anaesthesia and ASA ≥3 were significantly associated to this.