Immediate admission to hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study

Dinamarca-Montecinos, José Luis, Vásquez Leiva, Alejandra, Ruggiero, Carmelinda, Fernández Barrera, Yasna, Delgado, Rayén Gac, Carrillo, Ada, Lazcano, Gedeón Améstica, Vásquez Ulloa, Daniel, Aranda, Fernando, Pizarro Canales, Andrés, Mardones, Graciela, Gherardelli Morales, Constanza, Novik Assael, Victoria, Sepúlveda, Osvaldo, Acuña, Jossie, Aravena Arancibia, Carola, Ibarra, Julio, Bell, Jack and Sutton, Emma (2025) Immediate admission to hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study. The Journal of Frailty & Aging, 14 (3). ISSN 2273-4309

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Abstract

Background: Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48–72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed. Objective: To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients. Design: Before-and-after study, between 01/01/2017–09/30/2019; 12 months before and 21 months after implementation. Setting: Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile. Participants: Anonymised data of 902 hip-fractured older adults (≥ 60 years). Intervention: Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis. Measurements: Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used. Results: After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000). Conclusion: Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.

Item Type:	Article
Additional Information:	Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User:	LivePure Connector
Date Deposited:	27 Jan 2026 18:30
Last Modified:	28 Jan 2026 09:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101757
DOI:	10.1016/j.tjfa.2025.100014

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