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Discussing risk with patients
– using NHFD data to inform discussions
Antony Johansen, Carmen Tsang, Chris Boulton
Viv Burgon, David Cromwell and Rob Wakeman
National Hip Fracture Database
www.nhfd.co.uk
www.nhfd.co.uk - accessed 6th November 2016
All hospitals – unadjusted 30 day mortality
Case study
“Can I make her fitter?
“Can she lie flat?”
“Why isn’t she first on the list?”
“Can I make her any fitter?”
“She may die on the table”
National Confidential Enquiry
into Peri-operative Deaths
www.ncepod.org.uk - 2001
Reasons for postponement
of hip fracture surgery
Methods
We used NHFD data to examine inpatient mortality for 64,864
patients who presented with hip fracture in 2015
We excluded patients where ASA grade, date of surgery or date
of discharge were missing
Stratified by American Society of Anaesthesiologists (ASA) grade
ASA grading in
different units
Over half of
patients were
graded ASA 3
NHFD report 2016
Results
6.6% of the remaining 59,369 patients died in hospital
A third (34.7%) of inpatient deaths were in ASA 4 patients
Conclusions
High “relative risk” might discourage surgeons and anaesthetists from offering an operation, and deter patients and their loved ones from agreeing to it
Over 98% of ASA 4 patients survived the day of surgery, and the day after it, and only 16.5% died as inpatients Discussion should set this level of risk against the 48.6% mortality seen in those who received non-operative care
antony.johansen@wales.nhs.uk
www.nhfd.co.uk
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