Between-hospital variability in the management and outcomes of postoperative periprosthetic femoral fractures
Year: 2025
Type: article
Study design: Observational Study
Abstract: Aims: Postoperative periprosthetic femoral fractures (POPFFs) following hip arthroplasty pose complex challenges, with differences in management and outcomes across healthcare facilities. However, there is limited published literature on such variability to inform improvement initiatives. This study aims to quantify the between-hospital variations in surgical management and short-term outcomes. Methods: Administrative hospitalizations data from all 177 NHS hospital Trusts in England were analyzed for patients aged 18 years and above with a primary diagnosis of POPFF between April 2016 and December 2022. Patient demographic characteristics, comorbidities, procedures, length of stay, in-hospital mortality, 30-day total mortality (in or out of hospital), and emergency 30-day all-cause readmissions were extracted. Multilevel models with random intercepts for hospitals and funnel plots assessed the non-random variations between hospitals in procedures and outcomes. Results: Among 39,035 hospitalized patients, 66% were female (n = 25,720), with a median age of 82 years (IQR 73 to 88). Hospital variation existed in treatment outcomes, with adjusted intraclass correlation coefficients for fixation without revision, revision, and no surgical procedure of 4.0%, 3.8%, and 2.4%, respectively. Funnel plots revealed hospital outliers for procedure choice after adjusting for age, sex, and number of comorbidities - among 177 hospitals, nine (5.1%) exceeded the upper 95% control limit for fixation and 17 (9.6%) did so for revision; outlier proportions were 14.1% for length of stay, 3.9% for emergency 30-day readmission, and 1.1% for mortality. Conclusion: Inter-hospital variation exists for the management and short-term outcomes following POPFFs in England. This warrants further explanation to better understand the reasons for this.
Source: Bone & Joint Open
Institutions: Imperial College London, University of Exeter, Northumbria Healthcare NHS Foundation Trust, Wythenshawe Hospital, Lancaster University, University Hospital of Wales, Royal College of Physicians, Cardiff University, University of Warwick, University of Leeds, University Hospital Southampton NHS Foundation Trust
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $981
Funders: Eli Lilly and Company, AstraZeneca, National Institute for Health and Care Research, Department of Health and Social Care, Imperial College London, Imperial College Healthcare NHS Trust, Health Services and Delivery Research Programme, NIHR Imperial Biomedical Research Centre, School of Public Health, Imperial College London
OpenAlex ID: W4413897494