Abstract
Introduction
Process changes in the perioperative setting are rarely analysed, as their results
are not immediately tangible and require a high case volume. The primary objective
of this study was to retrospectively evaluate process changes using proximal femur
fractures (PFF) and to examine their effect using various outcome measures. The secondary
objective was to define potential quality criteria for the management of PFF.
Patients/Materials
This study included a retrospective analysis of the database of a level-1 trauma centre
for PFF. All PFF treated with osteosynthesis and endoprosthesis during the treatment
period from 1 January 2006 to 31 December 2021, were included. The 16-year period
was trichotomously divided for statistical analysis, and the first 6 years were used
as the baseline. A total of 10 process changes were implemented in the subsequent
10 years. The impact of these changes was assessed using operative revision rate,
infection rate, perioperative transfusion rate, and 1-year mortality.
Results
A total of 4,163 PFF were analysed. Regarding the outcome measures, changes in the
first 5 years (2012–2016; intramedullary procedures for osteosynthesis and use of
disposable drape and gown) showed the most significant effect, with sustained reduction
in long-term surgical revision rate of < 10%. Further process optimisations over the
past 5 years (2017–2021) also yielded measurable improvements (reduction in infection
and transfusion rates). The 1-year mortality remained unchanged, even during the COVID-19
pandemic.
Conclusion
Process changes in PFF do not immediately lead to objectively measurable improvements.
In retrospect, the paradigm shift from extra- to intramedullary osteosynthesis appears
to have the greatest effect, although gradual improvements were noted in all outcome
measures over the past 10 years, except for mortality. An objective quality control
target should aim for a 1-year revision rate of < 10%.
Schlüsselwörter
proximale Femurfraktur - Prozessänderungen - Revision - Outcome - Letalität
