Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture - 20/02/19
, A. Arnau b, c, J.V. Lorente a, b, L. Maestro d, J. Bosch bAbstract |
Study objective |
We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.
Design |
A non-randomized intervention study with a historical control group (CG).
Setting |
During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.
Patients |
240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).
Interventions |
CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.
Measurements |
The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.
Main results |
512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42–0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44–0.93) were the protective factors for mortality.
Conclusions |
The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Hip fracture is associated with high morbi-mortality in elderly patients. |
• | A multidisciplinary approach could be reduced postoperative complications and hospital stay. |
• | Surgical delay may not be associated with higher mortality rates. |
• | Main objective of comprehensive care should be to optimize patient's health status. |
Keywords : Clinical pathway, Hip fracture, Mortality, Postoperative complications, Surgical delay
Plan
Vol 53
P. 11-19 - mars 2019 Retour au numéro
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