Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study.

The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture. INTRODUCTION: We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture. METHODS: This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ≥65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders. RESULTS: Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63-0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69-0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91-0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay. CONCLUSIONS: Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.

Pain-related unscheduled contact with healthcare services after outpatient surgery.

This prospective, observational study explored the need for pain-related unscheduled contact with healthcare services after outpatient surgery. We hypothesised that 10% of outpatients would have pain-related unscheduled contact with healthcare services, and that the incidence would differ depending on the type of surgical procedure. In total, 905 patients who had undergone one of five common outpatient surgical procedures (knee or shoulder arthroscopy, surgical correction of hallux valgus, laparoscopic cholecystectomy or laparoscopic gynaecological procedures) completed an electronic questionnaire one week and eight weeks after surgery. Data from 732 patients (81%) were available for analysis. Within the first eight weeks after surgery, 150 patients (20.5%) had made unscheduled contact with healthcare professionals, in 247 cases due to pain that was most frequent in the first postoperative week. Risk factors were female sex, unemployment and laparoscopic cholecystectomy. The most frequent healthcare contact was with the general practitioner (46.4%), and the most frequent outcome was further information and guidance (41.2%). We have demonstrated that a minority of patients still needed to make contact with health services after outpatient surgery, most often due to inadequate pain management. This finding should be considered when planning postoperative monitoring and care, and developing postoperative patient education.

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis.

UNLABELLED: We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28-60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. LEVEL OF EVIDENCE: IV.