Population attributable fractions (PAFs) were used to quantify the anticipated reduction in the primary outcomes (30-day mortality and readmission) that would result from complete prevention of 10 postoperative complications. In 17,755 patients who underwent hip fracture repair across 117 hospitals, postoperative delirium and pneumonia were the highest-impact complications.

Postoperative delirium affected 29.8% of patients and was associated with:

• 30-day mortality (11.5%)
• Prolonged hospitalization (43%)
• 30-day hospital readmission (11.9%)

Pneumonia affected 4.1% of patients and was associated with:

• 30-day mortality (27.3%)
• Prolonged hospitalization (66%)
• 30-day hospital readmission (28.1%)

The impact of the other eight complications – bleeding, Clostridium difficile colitis, decubitus ulcer, myocardial infarction, stroke, surgical site infection, urinary tract infection and venous thromboembolism – was comparatively small.

“Using an interprofessional team-based approach to identify and mitigate perioperative risks, for delirium and pneumonia in particular, hospitals may be able to improve key patient outcome measures such as mortality, length of stay and readmissions,” notes an accompanying editorial by Lindee Strizich, MD, MSc and Christopher S. Kim, MD, MBA.

Also featured in the April issue:

• Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program (Durham Veterans Affairs Health Care System, Durham, North Carolina)
• Using a Modified Surprise Question as a Tool to Improve Primary Palliative Care in a Neurocritical Care Unit (Indiana University Health, Indianapolis)
• Improving Handoff by Deliberate Cognitive Processing: Results from a Randomized-Controlled Experimental Study (three pediatric hospitals in the Netherlands)
• Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff (University of Pennsylvania, Philadelphia)
• Intermittent Education and Audit and Feedback Reduce Inappropriate Prescribing of Oral Third-Generation Cephalosporins for Pediatric Upper Respiratory Tract Infections (Texas Children’s Hospital, Houston)
• What’s in a Name? Enhancing Communication in the Operating Room with the Use of Names and Roles on Surgical Caps (Lucile Packward Children’s Hospital, Palo Alto, California)
• Health System Leaders’ Role in Addressing Racism: Time to Prioritize Eliminating Health Care Disparities (Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore)
• Open Notes: New Federal Rules Promoting Open and Transparent Communication (editorial)

For more information, visit The Joint Commission Journal on Quality and Patient Safety website.

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Note for editors
The article is “The Relative Impact of Specific Postoperative Complications on Older Patients Undergoing Hip Fracture Repair” by Christopher C. Stahl, MD; Luke M. Funk, MD, MPH; Jessica R. Schumacher, PhD, MS; Ben L. Zarzaur, MD, MPH; and John E. Scarborough, MD. The article appears in The Joint Commission Journal on Quality and Patient Safety, volume 47, number 4 (April 2021), published by Elsevier.

The Joint Commission Journal on Quality and
Patient Safety
The Joint Commission Journal on Quality and Patient Safety (JQPS) is a peer-reviewed journal providing health care professionals with innovative thinking, strategies and practices in improving quality and safety in health care. JQPS is the official journal of The Joint Commission and Joint Commission Resources, Inc. Original case studies, program or project reports, reports of new methodologies or the new application of methodologies, research studies, and commentaries on issues and practices are all considered.

1 Brauer CA, et al. Incidence and mortality of hip fractures in the United States. JAMA. 2009 Oct 14;302:1573–1579.
2 Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017 Nov 23;377:2053–2062.
3 Kim SH, et al. Hip fractures in the United States: 2008 nationwide emergency department sample. Arthritis Care Res (Hoboken). 2012;64:751–757.