• Rüdiger Smektala, Angelika Grams, Ludger Pientka, and Ulrich Schulze Raestrup.
• Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinik der Ruhr-Universität Bochum, In der Schornau 23-25, Bochum, Germany. ruediger.smektala@ruhr-uni-bochum.de
• Dtsch Arztebl Int. 2008 Apr 1; 105 (16): 295-302.

IntroductionThis study analyzes healthcare management patterns in the German Federal State of North Rhine-Westphalia, with regard to time-to-surgery and operative technique in the management of femoral neck fracture.MethodsAnalysis of external quality assurance data relating to inpatient episodes of femoral neck fracture for North Rhine-Westphalia in the years 2004 and 2005. The study included data on 19 767 patients.ResultsMore than half of patients receive surgery within 24 hours of hospital admission. Large regional differences exist in relation to the type and timing of surgery. Day of the week is a key determinant of the timing of surgery. Even younger patients, in whom the hip joint should be preserved, receive delayed surgery in some regions.DiscussionStructured dialog with individual hospitals revealed the following causes for the differences in care provision: guideline recommendations and the recommendations of the Federal Office for Quality Assurance ltd. (Bundesgeschäftsstelle Qualitätssicherung, BQS GmbH), are not accepted as the basis for practice in all quarters; in some areas the necessary staff to ensure timely surgery are lacking. This situation cannot be defended to a wider public, given the clear indications from international literature that a short time to surgery reduces postoperative mortality as well as the incidence of key complications, such as pressure sores, thromboembolisms and pneumonia.

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