Improving Efficiency of Hip Fracture Care by Simplifying Wound Management and Eliminating Unnecessary Clinical Follow-Up.

Background: We conducted a retrospective review of geriatric hip fractures at our institution evaluating how a change in practice to 2-octyl cyanoacrylate adhesive (Dermabond®) with polyester mesh (Prineo®) and elimination of the 2-week follow-up visit impacts quality and efficiency of care after hip fracture. Our aim was to determine the impact of simplified wound closure and extended clinical follow-up on the number of outpatient calls to nurses and wound complications.

Methods: Patients included in this assessment were aged ≥65 years who underwent surgical fixation or hip replacement for proximal femur fracture during a one-year period preceding and following the implementation of Prineo® usage in wound closure (January 1 2017 to December 31, 2018). Information on demographics, comorbidities, nutritional screening, discharge location, wound complications, follow-up rates, and number of call-ins to the on-call nursing line within 6 weeks of surgery were collected via chart review. Cohort demographics and categorical outcomes were compared using Chi Square analysis and Wilcoxon Rank Sum test for continuous variables. The relationships between demographics, wound closure, fracture characteristics, and postoperative SSI was modeled with logistic regression.

Results: A total of 208 (n = 110 pre-practice change) patients were included in this analysis. No differences in age, sex, comorbidity rates, or race were identified between groups at baseline (p >.05). Outcomes analysis of Discharge Disposition, Length of Hospital Stay, SSI, 30 Day Mortality and Readmission found no significant differences between groups. Utilization of the nursing call service did not vary between groups within 6-weeks of surgery (p >.05).

Conclusions: The findings from this study underscore the utility of this closure system in hip fracture wound care and are in concurrence with other studies of Prineo® system that found no significant increase in wound complications up to 6 weeks after surgery.

Clinical Relevance: The benefits of this surgical site closure system include the elimination of a 2-week follow-up and consequential reduction in unnecessary visits. Future analysis is needed to assess more long-term follow-up, determine the cost savings impact of this practice, potential SSI reduction, and assess its application in other surgical settings. Level of Evidence: IV .