Guidance advises same day hip operations for fractures

hip fracture Half of patients who suffer a fracture are left with permanent disability

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Patients with a broken hip should be offered surgery as soon as they are admitted to hospital, recommends new guidance that criticises current NHS waiting times in England.

Currently, half of patients wait over 36 hours and some wait several days before hip surgery, and the National Institute for Health and Clinical Excellence says this is too long.

Outcomes are often poor - one in three die within 12 months.

Prompt surgery could help change this.

The new recommendations for England say timely surgery and effective treatment including physiotherapy after the operation can significantly improve patients' lives, reducing the length of their hospital stay and getting them back on their feet sooner.

Hip fractures are a serious problem which affect 1 in 6 women and some men. Around 75,000 hip fractures occur each year in the UK, costing the NHS £2bn a year in medical and social care.

A long, painful wait

74-year-old Sheila Bex, from West Sussex, waited in pain for over a fortnight with a broken hip due to brittle bones before having her surgery.

In A&E her symptoms were dismissed by a doctor as groin pain and she was sent home with a walking frame.

But the pain persisted and 12 days later she returned to her GP and was sent for an x-ray.

This revealed that she had a fracture and needed immediate surgery.

She was admitted to hospital but it took another three days and two cancelled operations before she finally had her surgery.

Sheila has made a good recovery and still manages to live an independent life, but she hopes the new guidelines will mean others do not have to suffer a similar plight.

NICE says the changes it recommends would cost very little to implement and would save money in the long-term.

It wants patients to be operated on either the same day, or the day after, hospital admission.

And immediately after the surgery a team of different experts, including surgeons, physicians, anaesthetists, nurses and physiotherapists, should work out a care plan to to help patients regain their mobility and independence as quickly as possible.

Falls and hip fractures in adults are often a sign of underlying ill health and a co-ordinated multidisciplinary approach from hospital admission to discharge is essential, says NICE.

Tim Chesser, a consultant orthopaedic and trauma surgeon who helped develop the guidelines, said: "Hip fractures are a major issue - they affect more women than breast cancer. Although there have been big improvements in the quality of NHS care, we know that, nationally, some patients are still waiting too long for surgery.

"Prompt planned surgery by an experienced team can lead to better outcomes for the patient, so this guideline is a real opportunity to spread good practice by recommending that appropriate surgery by an experienced consultant takes place the same day, or day after, a patient is admitted to hospital."

Michelle Mitchell of the charity Age UK said: "When it comes to hip fractures, the difference between good and bad care can be life changing, yet currently many people are subject to variability in terms of treatment.

"It's imperative NICE guidelines are implemented throughout the country to raise standards of care for people suffering hip fractures and avoid the devastating effects of poor treatment."

Dr Claire Bowring, from the National Osteoporosis Society, welcomed the guidance: "The consequences of a hip fracture can be devastating so prompt management and treatment is essential.

"There are now 78,000 hip fractures a year, 10% of these people will be dead within 30 days; 30% will be dead within a year."

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