Introduction of new guidelines for emergency patients: motivational counselling among smokers

Introduction: Smoking is the most important risk factor for morbidity and mortality in hospital patients. Patient contact with the healthcare system should include smoking cessation counselling. Emergency admissions are seldom given this opportunity.Objective: The aim of the study was to illustrate the implementation of motivational counselling in a department of acute surgery.Methods: Between May 2003 and January 2004, 200 emergency patients were offered motivational counselling and a 6‐week smoking cessation programme.Results: We measured the number of patients who accepted motivational counselling. Of the initial 200 patients, 121 (61%) accepted motivational counselling. The only factor related to the level of motivation was age. The most motivated group had an average age of 45 years, whereas the average age of the least motivated group was 64. There was no correlation between the Fagerstrom score, pack‐years, gender, illness, employment, or alcohol consumption and the outcome. Fifty‐seven patients agreed to us following them up, of which 10% quit smoking for 6 months; 44% either quit or reduced their smoking for a shorter period of time, and 17% of the continuing smokers requested admission to the smoking cessation programme.Conclusion: The majority of smokers acutely admitted to an acute orthopaedic department accepted motivational counselling against smoking, the youngest being the most motivated. It appears possible to implement motivational counselling for smoking cessation in an acute orthopaedic department. It is relevant to consider how, and for which groups, a smoking intervention programme can be offered to acutely admitted patients

Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays?:A retrospective study of 38,020 patients

BACKGROUND AND PURPOSE: Hip fractures are associated with high mortality, but the cause of this is still not entirely clear. We investigated the effect of surgical delay, weekends, holidays, and time of day admission on mortality in hip fracture patients. PATIENTS AND METHODS: Using data from the Danish National Indicator Project, we identified 38,020 patients admitted from 2003 to 2010. Logistic regression analysis was used to study the association between sex, age, weekend or holiday admission, night-time admission, time to surgery, and ASA score on the one hand and mortality on the other. RESULTS: The risk of death in hospital increased with surgical delay (odds ratio (OR) = 1.3 per 24 h of delay), ASA score (OR (per point added) = 2.3), sex (OR for men 2.2), and age (OR (per 5 years) = 1.4). The mortality rate for patients admitted during weekends or public holidays, or at night, was similar to that found for those admitted during working days. INTERPRETATION: Minimizing surgical delay is the most important factor in reducing mortality in hip fracture patients

Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

Introduction: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. Materials and Methods: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture are registered in a local database, and data are retrieved retrospectively using the Danish Civil Registration Number. Results: We included 993 patients in the intervention group and 989 patients in the control group. A univariate analysis showed only significantly decreased mortality inhospital 6.3% vs 3.1% ( P = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days [OR 0.72] and 1 year [OR 0.79]). When using a univariate analysis for home-dwelling patients, we found significantly reduced mortality inhospital (8.3-2.0%, P < .0001), after 30 days (12.2-6.8%, P = .004) and 90 days (20.5-13.0%, P = .002). One-year mortality was not significant. Patients from nursing homes had no significant decreasing mortality at any point of time in the univariate analysis. Conclusion: We have shown significant decreases for inhospital, 30 day, 90 day, and 1-year mortality after implementation of orthogeriatric service at Bispebjerg Hospital when adjusting for age, gender, and ASA score. Future trials should include frail patients with other fracture types who can benefit from orthogeriatrics