Title : Improving post-operative mortality by early identification of cognitive impairment in femoral fracture patients in patients over 65
Abstract:
There are approximately 80,000 hip fractures treated in UK alone costing over 2 billion pounds. Studies have found that hip fracture patients with reduced cognition have a higher overall risk of complications, mortality and reduced long-term outcome. Data was collected retrospectively between the periods of Nov - Dec 2020 and Jan - Feb 2021 in patients who sustained a femoral fracture over the age of 65, requiring surgical management. The first cycle involved analysis of 141 patients; of these 46% of patients had pre-operative reduced cognition (AMTS ≤ 7) and the mortality rate amongst this group was 10.6%. We presented our findings and educated all staff to assess cognition both pre and post-operatively. Trust guidelines were changed to ensure cognitive assessment both pre and post operative in femoral fracture patients. The second cycle after our intervention, found that mortality rates decreased to 1.38% (compared to previous 10.6%) in patients with reduced cognition pre-operatively. Mortality rate significantly reduced after cognitive assessment improved within the trust. Interestingly cognitive impairment in itself is a risk factor of developing a hip fracture. There is therefore a large overlap between hip fractures and cognitive decline and we must be mindful to assess cognition to predict a higher mortality risk in our patients - especially those over 65. Increased assessment of cognition significantly reduced the mortality rate, overall risk of complications and length of patient stay - hence helping to reduce the economic burden on the National Health Service.
