This is a feature story about the potential benefits in treating hip fractures as a critical emergency, and providing “fast-track” access to surgery to improve outcomes. As the story indicates, limited research so far shows that waiting more than a day or so leads to a higher risk of complications and death.
This story covered a lot of the basics, giving readers an overview of where the research stands, and why doctors hypothesize this method is better. That said, it could have emphasized that surgery is still surgery, and while this approach may reduce complications, there are still risks. More also was needed on the measured benefits and general availability of this option.
Among older adults, hip fractures are common and have a big impact on quality of life. For readers at risk of a hip fracture, or who have loved ones at risk, this story is likely to be of high interest, and it’s important they come away fully informed–even if things like costs and harms may be less than standard slower treatment, they should not be overlooked altogether.
The story does not discuss costs, and this is an important oversight considering how expensive inpatient surgery is. Presumably this fast-track surgery is less expensive since it reduces time spent in the hospital, but we’re not giving any specifics.
The story doesn’t get into the measured specifics. We’re told delayed surgery creates a “significantly higher overall complication rate. And surgery two days and three or more days after admission was associated with higher rates of death.” But without actual numbers, it’s unclear how significant these rates are.
There are no harms discussed in the story. We can presume that faster surgery is safer, but whether hip repair is done rapidly or after three days, all surgical patients are at risk of harm, and so the risks should be discussed.
The story provides a good overview of the evidence, letting us know that fast-track hip surgery has been studied on a pilot basis, and is now being studied in a new large international clinical trial to help clarify how beneficial it is.
The story quotes two experts involved with research, but also one more who appears independent of it, as well as a patient. There also appear to be no notable conflicts of interest.
This story is a comparison of alternatives, comparing established methods with newer methods.
It’s not clear how widely available this fast-track surgery option is in general, but this is something you’d want to know if you were a patient/caregiver trying to find some place that offers this.
The story calls this a new approach, but in reality “fast-track” surgery has been used in many institutions for a long time (but it has not been standardized across the country).
It does not appear that there was a news release on this topic that instigated the story.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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