TY - JOUR
T1 - Femoral neck fractures
T2 - Evidence versus beliefs about predictors of outcome
AU - Zlowodzki, Michael
AU - Tornetta, Paul
AU - Haidukewych, George
AU - Hanson, Beate P.
AU - Petrisor, Brad
AU - Swiontkowski, Marc F.
AU - Schemitsch, Emil H.
AU - Giannoudis, Peter V.
AU - Bhandari, Mohit
PY - 2009/4
Y1 - 2009/4
N2 - It is unclear whether current practice reflects current evidence on predictors of clinically important outcomes like mortality and fixation failure. Knowledge of predictors of outcome can and should influence treatment decisions and can subsequently improve outcomes. We hypothesized that there is evidence about the significance of predictors of outcome not being considered in the decision making process in the treatment of hip fractures because many surgeons are unaware of it. We surveyed 298 North American and European orthopedic surgeons to examine their training and experience and their opinion on the relative importance of predictors of outcome of femoral neck fracture treatment. We compared the results with the highest level of therapeutic and prognostic evidence currently available. Surgeons' perceptions about the importance of the quality of fracture reduction, patient comorbidities, degree of fracture displacement, dementia, and prefracture walking ability were justified by the current literature. However, we further identified a number of variables deemed unimportant to surgeons that have evidence to support their use in managing patients with hip fractures, including the type of anesthesia as a modifiable variable. In contrast to surgeons' perceptions, the available evidence suggests regional anesthesia is associated with a lower mortality risk than general anesthesia.
AB - It is unclear whether current practice reflects current evidence on predictors of clinically important outcomes like mortality and fixation failure. Knowledge of predictors of outcome can and should influence treatment decisions and can subsequently improve outcomes. We hypothesized that there is evidence about the significance of predictors of outcome not being considered in the decision making process in the treatment of hip fractures because many surgeons are unaware of it. We surveyed 298 North American and European orthopedic surgeons to examine their training and experience and their opinion on the relative importance of predictors of outcome of femoral neck fracture treatment. We compared the results with the highest level of therapeutic and prognostic evidence currently available. Surgeons' perceptions about the importance of the quality of fracture reduction, patient comorbidities, degree of fracture displacement, dementia, and prefracture walking ability were justified by the current literature. However, we further identified a number of variables deemed unimportant to surgeons that have evidence to support their use in managing patients with hip fractures, including the type of anesthesia as a modifiable variable. In contrast to surgeons' perceptions, the available evidence suggests regional anesthesia is associated with a lower mortality risk than general anesthesia.
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M3 - Article
C2 - 19388614
AN - SCOPUS:67649132878
SN - 0147-7447
VL - 32
SP - 260
JO - Orthopedics
JF - Orthopedics
IS - 4
ER -