61 HIP Fracture Management of Older Adults in a Public Tertiary Hospital in Kuala Lumpur: Analysis and Comparison with the Standard of Care in UK

Background There has been rapid improvement in evidence-based care for hip fracture in UK in which prompt, effective, multidisciplinary management has been shown to improve quality and reduce costs. The aim of this study was to evaluate the current outcome of hip fractures in our hospital, and to compare it to the outcome of evidence-based management of hip fractures in UK. Methods A cross-sectional study of all hip fracture patients aged 60 and above, admitted from 1st March 2018 until 28th Feb 2019. Medical records of 105 patients obtained from a hip fracture registry were reviewed. Clinical data such as patients’ sociodemographics, fall circumstances, fractures, peri-operative details, complications and mortality were extracted and analysed. Results The surgery rate was 67% (96.5% in UK). Among the 37 patients (35.2%) not operated, 15 refused operation. Rate of early surgery was only 9.3% (71.3% in UK). Medical stabilisation (28.2%) and no operating time (40.8%) were the main reasons for surgical delay. None had falls assessment (98% in UK) and only 7.6% was started on bone protection prior to discharge (60% in UK). The average length of stay was 17 days (15.8 days in UK). The 30 day mortality was 9.5% (8.5% in UK). Discussion Our results showed that there was no significant difference in length of stay and 30 day mortality compared to UK. However, this may be due to our small sample size. Lack of awareness of falls assessment and bone protection suggests that our current model of care needed improvement. Conclusion Our results highlighted the need to implement proactive strategies to improve the management of hip fracture in our centre. Ortho-geriatrics shared-care in hip fracture management was subsequently implemented in an effort to improve patient care and service. Further studies need to be done to re-evaluate the outcomes post implementation.