Journal of clinical anesthesia | 2019
Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture.
Abstract
STUDY OBJECTIVE\nWe 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.\n\n\nDESIGN\nA non-randomized intervention study with a historical control group (CG).\n\n\nSETTING\nDuring the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12\u202fmonths post-discharge.\n\n\nPATIENTS\n240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).\n\n\nINTERVENTIONS\nCG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.\n\n\nMEASUREMENTS\nThe 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.\n\n\nMAIN RESULTS\n512 patients (CG\u202f=\u202f240; IG\u202f=\u202f272). Mean age was 83.8\u202fyears in CG and 84.9\u202fyears in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p\u202f<\u202f0.001) and took more drugs (p\u202f<\u202f0.001). Surgery was performed within 48\u202fh of admission in 55.1% of patients of the IG (38.3% CG; p\u202f<\u202f0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p\u202f=\u202f0.025) and hospital stay was shorter in the IG (p\u202f<\u202f0.001). A surgical delay of >48\u202fh (HR\u202f=\u202f0.61; CI95%: 0.42-0.88) and allocation to the IG (HR\u202f=\u202f0.64; CI95%: 0.44-0.93) were the protective factors for mortality.\n\n\nCONCLUSIONS\nThe 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.