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dc.contributor.authorGjertsen, Jan Erik
dc.contributor.authorStensland, Eva
dc.contributor.authorByhring, Hanne Sigrun
dc.contributor.authorDybvik, Eva Hansen
dc.contributor.authorSøreide, Odd
dc.contributor.authorKjærvik, Cato
dc.date.accessioned2021-02-25T11:47:15Z
dc.date.available2021-02-25T11:47:15Z
dc.date.created2020-12-15T08:32:17Z
dc.date.issued2020
dc.PublishedBone & Joint Open. 2020, 1 (10), 644-653.
dc.identifier.issn2633-1462
dc.identifier.urihttps://hdl.handle.net/11250/2730380
dc.description.abstractAims The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence. Methods International and national guidelines were identified and treatment recommendations extracted. All 43 hospitals routinely treating hip fractures in Norway were characterized. From the Norwegian Hip Fracture Register (NHFR), hip fracture patients aged > 65 years and operated in the period January 2014 to December 2018 for fractures with conclusive treatment guidelines were included (n = 29,613: femoral neck fractures (n = 21,325), stable trochanteric fractures (n = 5,546), inter- and subtrochanteric fractures (n = 2,742)). Adherence to treatment recommendations and a composite indicator of best practice were analyzed. Patient survival and reoperations were evaluated for each recommendation. Results Median age of the patients was 84 (IQR 77 to 89) years and 69% (20,427/29,613) were women. Overall, 79% (23,390/29,613) were treated within 48 hours, and 80% (23,635/29,613) by a surgeon with more than three years’ experience. Adherence to guidelines varied substantially but was markedly better in 2018 than in 2014. Having a dedicated hip fracture unit (OR 1.06, 95%CI 1.01 to 1.11) and a hospital hip fracture programme (OR 1.16, 95% CI 1.06 to 1.27) increased the probability of treatment according to best practice. Surgery after 48 hours increased one-year mortality significantly (OR 1.13, 95% CI 1.05 to 1.22; p = 0.001). Alternative treatment to arthroplasty for displaced femoral neck fractures (FNFs) increased mortality after 30 days (OR 1.29, 95% CI 1.03 to 1.62)) and one year (OR 1.45, 95% CI 1.22 to 1.72), and also increased the number of reoperations (OR 4.61, 95% CI 3.73 to 5.71). An uncemented stem increased the risk of reoperation significantly (OR 1.23, 95% CI 1.02 to 1.48; p = 0.030). Conclusion Our study demonstrates a substantial variation between hospitals in adherence to evidence-based guidelines for treatment of hip fractures in Norway. Non-adherence can be ascribed to in-hospital factors. Poor adherence has significant negative consequences for patients in the form of increased mortality rates at 30 and 365 days post-treatment and in reoperation rates.en_US
dc.language.isoengen_US
dc.publisherBritish Editorial Society of Bone and Joint Surgeryen_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/deed.no*
dc.titleHip fracture treatment in Norway - deviation from evidence-based treatment guidelines: data from the Norwegian Hip Fracture Register, 2014 to 2018en_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.rights.holderCopyright 2020 Author(s) et al.en_US
cristin.ispublishedtrue
cristin.fulltextoriginal
dc.identifier.doi10.1302/2633-1462.110.BJO-2020-0124.R1
dc.identifier.cristin1859804
dc.source.journalBone & Joint Openen_US
dc.source.401
dc.source.1410
dc.source.pagenumber644-653en_US
dc.identifier.citationBone & Joint Open. 2020, 1 (10), 644–653.en_US
dc.source.volume1en_US
dc.source.issue10en_US


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Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal
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