FACTORS AFFECTING THE OUTCOME AFTER PROXIMAL FEMORAL FRACTURES

One hundred and forty-two consecutive patients with proximal femoral f ractures were audited prospectively over a 1-year period. Mobility, ag e and sex were recorded along with timing of surgery, complications, ' will to live, length of admission, mortality, mobility and housing req uirements on discharge. Operative procedures were performed mostly by intermediate surgical staff, on night-time emergency lists shared with other specialities. Patients were treated on a ward with nursing staf f levels less than the minimum recommended by professional bodies. Mea n hospital stay was 31 days. In-patient mortality was 37 per cent in m ales and 5 per cent in females. It was possible to predict protracted hospital stay in 84 per cent, mortality in 84 per cent, mobility on di scharge in 92 per cent and need for rehousing in 83 per cent of patien ts. Of the 10 principal variables that affected outcome, four could be influenced by hospital practice. These variables were associated with 1284 hospital bed days, which constituted 30 per cent of total bed oc cupancy. Fifty-five per cent of these were associated with non-medical delay to surgery, 25 per cent with wound infection or re-operation an d 20 per cent with broken pressure areas. There would appear to be the potential to improve outcome in proximal femoral fractures by stabili zing fractures within 24 h, adopting measures additional to antibiotic prophylaxis to reduce infection and ensuring that patients do not dev elop pressure sores.