Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Int Orthop. 2014 May;38(5):1045-50. doi: 10.1007/s00264-013-2218-5. Epub 2013 Dec 12.


Purpose: Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery.

Methods: This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N = 212), and the second was from January 7, 2010 to July 7, 2011 (N = 314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions.

Results: In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p < 0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p < 0.001); for internal fixation there was no significant difference (five versus six days, p = 0.557) and after Gamma nailing it decreased from ten to six days (p < 0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p = 0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p = 0.049). Readmissions for the total group were not different (16 % versus 17 %, p = 0.720).

Conclusions: Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Critical Pathways*
  • Female
  • Hip Fractures / surgery*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies