Subject(s)
Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/history , History, 20th Century , Humans , Prevalence , Prognosis , Radiography, Thoracic/methods , Respiratory Distress Syndrome/epidemiology , Risk Assessment , Survival Analysis , Tomography, X-Ray Computed/methodsABSTRACT
INTRODUCTION: The enhanced recovery programme (ERP) is used to improve patient experience before, during and after an operation. Initially designed for colorectal surgery, it has now been adopted by many other disciplines, including orthopaedics. Where applicable, ERP has shown to be associated with less pain, reduced length of hospital stay and increased patient satisfaction in elective orthopaedic procedures. There is, however, a paucity of data regarding the use of ERP in fractured neck of femur (NOF) operations. Our aim was to investigate the effect of ERP on analgesic requirements and hospital length of stay during hemiarthroplasty. METHOD: Consecutive notes of 100 patients who received a hemiarthroplasty for a fractured NOF were reviewed retrospectively. In one group (n = 50), patients received routine pre- and post-operative care; the second (n = 50) were on the ERP. All patients were previously mobile with an abbreviated mental test score of more than eight and lived in their own home. RESULTS: With ERP, oral opiate consumption fell dramatically in the first three post-operative days (4.7 vs. 14.0 mg, p > 0.005). The use of patient-controlled analgesia (PCA) was also significantly reduced (odds ratio 0.16, p > 0.05). Although ERP had no statistically significant effect on length of stay (7 vs. 8.5 days, p = 0.2), it saw a greater proportion of patients being discharged back to their own home (25 vs. 19 patients, p < 0.05). CONCLUSION: The ERP reduces post-operative oral opiates and PCA requirements in fractured NOF cases and by inference reduces pain. It does not appear to affect length of hospital stay in an acute unit.
Subject(s)
Analgesics, Opioid/therapeutic use , Arthroplasty, Replacement, Hip/rehabilitation , Hemiarthroplasty/rehabilitation , Pain Management/methods , Pain, Postoperative/drug therapy , Postoperative Care/methods , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Arthroplasty, Replacement, Hip/methods , Female , Hemiarthroplasty/methods , Humans , Male , Retrospective StudiesABSTRACT
There is a lack of consensus about how to treat intracapsular hip fractures in the 'young elderly' (50-75 years). Evidence for older more mobile patients seems to point towards Internal Fixation (IF) for undisplaced fractures and Total Hip Replacement (THR) for displaced fractures. Radiographs of 263 patients from the Norfolk and Norwich University Hospital, who have suffered an intracapsular hip fracture between 2000-2009 were reviewed. The complication and mortality rates were noted. A Hip function questionnaire (Oxford hip score (OHS)) and Numeric pain score (NPS) were sent out to patients, then methods of treatment (IF and THR) were compared. In displaced fractures THR compared favourably to IF, OHS (16.0 vs. 20.0 p 0.029), NPS (2.0 vs. 4.0 p 0.007), complications (Odds Ratio (OR) 2.90; p 0.006) and death rate (OR 3.61; p 0.007). Although not statistically significant when stratified for age, the youngest age group (50-60) still achieved better function with a THR (13.0 vs. 18.0 ; p 0.129). There was little difference in the results for undisplaced fractures. This retrospective cross-sectional study showed IF is associated with a much higher complication rate than THR for patients who sustained a displaced hip fracture. THR also showed a better functional outcome and reduced pain. IF should be used in undisplaced fractures as there was no difference in functional outcome or complication rate. A large randomised controlled trial is needed to confirm these results.
