ABSTRACT
BACKGROUND: Hip fractures are a common condition associated with high morbidity and mortality. In this study, we assess (1) yearly incidences, (2) demographic factors, (3) postoperative outcomes, (4) primary diagnoses, and (5) primary procedures. MATERIALS AND METHODS: The National Inpatient Sample was queried for patients admitted with hip fractures from 2009 to 2016 (n = 2 761 850). Variables analyzed were age, sex, race, obesity status, Charlson Comorbidity Index, smoking status, osteoporosis status, lengths of stay (LOS), discharge dispositions, charges, costs, mortalities, inpatient complications, primary and secondary diagnoses, and primary procedures. RESULTS: From 2009 to 2016, the overall gross number of hip fractures decreased (P < .001). At the conclusion of the study, more patients were male, obese, and smokers, while fewer had a diagnosis of osteoporosis (P < .001 for all). Mean LOS significantly decreased (P < .001), while charges and costs increased (P < .001 for both). Both mortality and the overall complication rate decreased (P < .001 for both). Specifically, complications that decreased included myocardial infarctions, deep vein thromboses, pulmonary emboli, pneumoniae, hematomas/seromas, urinary tract infections, and transfusions (P < .001 for all). Complications that increased included cardiac arrests, respiratory failures, mechanical complications, and sepsis (P < .001 for all). The most common diagnosis was "closed fracture of intertrochanteric section of neck of femur." The procedure performed most often was "open reduction of fracture with internal fixation, femur." CONCLUSION: An increasing number of males and smokers have sustained hip fractures, although fewer patients with osteoporosis experienced these injuries. A decreasing overall complication rate may indicate improving perioperative courses for hip fracture patients. However, several shortcomings still exist and can be improved to further decrease negative outcomes.
ABSTRACT
INTRODUCTION: An important global measure of health care quality is patient satisfaction. Patient satisfaction partially determines hospital reimbursement for procedures such as total hip arthroplasty (THA). Press Ganey (PG) survey responses assess patient satisfaction, and impact reimbursement. Current efforts to maximise repayment for THA include reducing postoperative pain. The "Pain Management" survey domain is considered a significant factor in patient ratings, but other studies have highlighted staff communication domains as determinants of satisfaction. Therefore, the purpose of this study is to compare PG survey responses to inpatient pain intensity. METHODS: We queried the PG database for all patients who underwent a THA between November 2012 and January 2015. This yielded a total of 302 patients. Descriptive statistics were performed to analyse patient-level demographics. A multivariate regression model was constructed utilising pain intensity as the dependent variable. RESULTS: Patients rating of "Communication with Doctors" (B = -25.534; p < 0.001) and "Communication about Medicines" (B = -31.49; p = < 0.001) domains were representative of patient pain intensity. No other factors demonstrated a significant relationship to pain intensity. CONCLUSIONS: Patient satisfaction continues to be important in care quality. Surrogate markers, such as the PG survey, can guide institutions looking to improve care. Our study revealed scores for "Communication with Doctors" and "Communication about Medicines" best represented true pain intensity levels for THA recipients during the postoperative period. The "Pain Management" domain did not display a relationship to pain intensity. The current method of measuring patient satisfaction should be reassessed to better represent patient responses and outcomes.
