Earlier operations for broken hip patients

22nd June 2011 - Surgery and care for NHS patients with broken hips should be improved to prevent long term disability or complications, according to new guidance from the NHS regulator.

The National Institute for Health and Clinical Excellence (NICE) says patients should have their operation on the same day or the day after hospital admission. It says that currently some patients have to wait several days before surgery.

The guidance also recommends that hospitals provide a co-ordinated programme of care to help patients recover faster, regain their mobility and ensure other health conditions are addressed.

Elderly patients

Professor Peter Littlejohns, Clinical and Public Health Director at NICE, says that established practice is to delay surgery on account of patients often being elderly and frail. "There has been a tendency to try and stabilise the condition before operating; so these patients have sometimes been waiting for a day, two days before the operation," he tells us.

The new guidance is clear that patients with broken hips should not be operated on as emergency cases, which might involve being treated by junior staff. Instead, they should be added to the next theatre list so that they are treated by a senior surgeon and senior anaesthetist. "There's increasing evidence to show that really what you need to do is to get senior staff to stabilise these patients quickly and to get them into theatre either on the same day or the following day," Littlejohns says.

Hip fracture programme

Another key component of the new guidance recognises that hip fractures are more than just a surgical concern. Because falls and hip fractures in adults often signal other health problems, such as heart disease and diabetes, it calls for a Hip Fracture Programme covering a patient's entire time in hospital.

The programme encourages different healthcare professionals, including surgeons, physicians, anaesthetists, nurses and physiotherapists to work closer together to offer co-ordinated care.

"You have designated people working with this programme - and if they all come together then they reduce the length of stay [in hospital] by six days," Littlejohns says. For instance, patients should be offered a physiotherapy assessment and start mobilisation, such as weight bearing and exercises, the day after surgery.

NICE says the new regime will improve the lives of thousands of patients and, in the long term, help save some of the estimated £2 billion a year spent on medical and social care treating UK hip fracture cases.

High death rate

Around 70-75,000 hip fractures occur each year in the UK, and figures are expected to rise even higher as a result of the ageing population. One in three of these patients die within 12 months - mostly because of other illnesses.

Tim Chesser, Consultant Orthopaedic and Trauma Surgeon, North Bristol NHS Trust, who helped develop the guidelines, says in a statement: “Hip fractures are a major issue - they affect more women than breast cancer. Although there have been big improvements in the quality of NHS care, we know that, nationally, some patients are still waiting too long for surgery.

“Prompt planned surgery by an experienced team can lead to better outcomes for the patient, so this guideline is a real opportunity to spread good practice by recommending that appropriate surgery by an experienced consultant takes place the same day, or day after, a patient is admitted to hospital.”

Michelle Mitchell, Charity Director at Age UK, says that while 30% of people suffering a hip fracture make a full recovery, half are permanently disabled. In a statement, Mitchell adds: "It’s imperative NICE guidelines are implemented throughout the country to raise standards of care for people suffering hip fractures and avoid the devastating effects of poor treatment."