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Trial Lecture – time and place
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Adjudication committee
- First opponent: Associate Professor Cecilia Rogmark, Lund University
- Second opponent: Professor Arild Aamodt, Lovisenberg Diakonale Sykehus
- Third member and chair of the evaluation committee: Associate Professor Thomas J. Kibsgård, University of Oslo
Chair of the Defence
Professor Emeritus Tom Øresland, Faculty of Medicine, University of Oslo
Principal Supervisor
Professor Asbjørn Årøen, Faculty of Medicine, University of Oslo
Summary
Hip fractures typically occur in the frail and elderly. They result in considerable morbidity and in increased mortality comparable to acute myocardial infarction. Deep surgical site infection after hip fracture surgery can worsen the functional outcome and seems to be associated with a further increase in mortality. Approximately every other hip fracture patient develops delirium.
The aim of this thesis, which is based on four observational studies, was to investigate possibilities to improve mortality, the incidence of surgical site infection, the functional outcome after revision for deep surgical site infection, and delirium in hip fracture patients.
We found that ‘fast-tracking’ hip fracture patients to the orthopaedic ward is safe. However, in light of our study and other available evidence, the effect of fast track hip fracture care on mortality seems to be limited.
Deep surgical site infection after hip fracture surgery is an independent risk factor for mortality. The role of the duration of surgery as a risk factor for surgical site infection is unclear. Our data, in conjunction with other reports, may indicate that the elapsed time during surgery could be less important than the reason for a prolonged operation.
When a deep surgical site infection after total hip arthroplasty is treated with debridement, antibiotics, and implant retention, the use of the posterior surgical approach is associated with better function and increased patient satisfaction compared to the transgluteal approach. However, most patients in our study had other indications for their total hip arthroplasty than an acute hip fracture. Therefore, it is unclear if this result can be extrapolated to hip fracture patients.
Orthogeriatric co-management reduced the incidence of delirium in our cohort of hip fracture patients. In conjunction with previous evidence, a clinically relevant effect of orthogeriatric co-management on the incidence of delirium in hip fracture patients seems probable.
Additional information
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