Anaesthesia Sprint Audit of Practice (ASAP) 3

Thursday, 3 October 2019

Periprosthetic Fractures - Observational Study

Anaesthesia Sprint Audit of Practice (ASAP) 3


Dear All,

 Hope you're well!

We've just finished an observational study, which has found what we think we all knew anyway: that periprosthetic femoral fractures (PPF) are becoming ever more common. Approximately 5500+ are recorded in England + Wales each year, increasing by 13% annually. This is probably an underestimate, because of coding problems. Certainly, in Brighton (a MTC) we're seeing 3 or 4 a week at the moment, with other local hospitals seeing 1-2/week.


This is good news in some ways, because it indicates that more of the frail elderly are surviving hip/knee arthroplasty or fracture to then go on and fracture around their prosthesis at a later date. However, it is probably also placing a lot of strain on hospitals logistically and financially. Our observational study reflects our experience: PFF patients are waiting a long time preop to see too few PPF surgeons for 'big', long surgery and anaesthesia which not all of them receive, after which not all of them return home.


A bit like hip fractures 10 years ago, then! Which is why we'd like to ask for your help in sorting these patients out ...


The aim is to try and achieve the same improvements in care for PPF patients that we've all achieved for hip fracture patients, but in half the time (5 years) using the knowledge we've learned from hip fracture management. The imminent Association of Anaesthetists guidelines will support this approach: 'The Working Party recommends that (the principles of hip fracture management) should apply to the peri-operative management of older or frail people with other long bone and peri-prosthetic fractures.'


We need accurate data to be able to make change happen.


The ASAP 1 and 2 studies that you all helped with collected astonishing amounts of accurate data, and resulted in valuable new insights into how anaesthetists should manage hip fracture patients.


We'd like your help in doing a similar observational study for PPF patients - ASAP 3!


Could we ask you to look at the Excel spreadsheet attached, and fill in as much as you can, please? There's no patient data collection for this first stage - it's just to give us an idea of whether ASAP 3 is possible.


Notes on completing the spreadsheet:

  1. Rows 5-20 provide simple data about what services you have at your hospital. Please enter appropriate data in column B, according to the explanatory notes in column D.
  2. Rows 27 onwards are the data fields we think are important to collect for ASAP 3. It's an ambitious number of data fields, but similar in scope to ASAP 1 (hips). Using the explanatory notes in column D again, could you indicate whether (1) you already collect this data about PPFs, in column B, or (2) you could collect this data for ASAP 3 , in column C, please?

ASAP 1 and 2 succeeded because we all felt involved in it, so can I ask you:

  1. To indicate whether you and your hospital will be willing to contribute data to ASAP 3, in row 113 (formal REC approval will be sought before starting the study)?
  2. To write any further comments about 'ASAP 3' in row 115?
  3. To suggest further data fields that we might all collect in row 121?
  4. To volunteer your help in co-ordinating the study with Richard, Subash and me in row 123?

We're aiming to start ASAP 3 formally in early 2020, so could I ask you to complete the Excel spreadsheet and return this to Stu ( by 31st October, 2019, please?


We know we're all hesitant to take on extra (unpaid) work, but we also know that we all find managing PPF patients can be frustrating. 'Crowdsourcing' data collection worked superbly in ASAP 1+2 for hip fractures, and we think we can do the same for PPFs: 2 patients/week x 3 months x 200 hospitals = ~5000 patients ...


And all data collectors will be acknowledged in the eventual write-up, of course ... extra brownie points for CPD/appraisal!


best wishes, and thanks in advance for your help,


Stu, Richard and Subash


Dr Stuart White

Consultant Anaesthetist, Brighton


Prof Richard Griffiths

Consultant Anaesthetist, Peterborough


Dr Subash Sivasubramaniam

Consultant Anaesthetist

Sandwell and West Birmingham Hospitals NHS Trust