Orthogeriatric multidisciplinary care for hip fractures in emergency department reduces length of stay: a retrospective cohort study

Abstract Background. Hip fractures represent a frequent reason for emergency department (ED) attendance among older adults and are associated with substantial morbidity and mortality. Orthogeriatric multidisciplinary care models, combining early clinical assessment, rapid diagnostics, tailored analgesia by regional anaesthesia (RA) and dedicated perioperative management, have been developed to improve care for these vulnerable patients. The specific impact of such models on ED length of stay (LOS) remains insufficiently studied. This study assessed the effect on ED LOS of implementing an orthogeriatric fast-track based on a multidisciplinary care model. Secondary objectives were to evaluate the impact of this implementation on analgesia efficiency in ED, complications rate and early mortality. Method. This monocentric observational study was conducted at Fribourg Hospital (42000 patients per year in the emergency room), Switzerland, including patients aged ≥ 65 years with hip fracture, before (n = 87) and after (n = 65) fast-track implementation. Exclusion criteria were RA contraindications, RA refusal from patient or an inability to give consent and polytrauma. The primary outcome was LOS in ED (i.e., time between ED admission to transfer out of ED). Secondary outcomes were analgesia efficiency in ED (i.e., NRS reduction, opioid consumption), 72-hours complications rate and 30-days mortality. Wilcoxon rank sum test was used for quantitative variables and Fisher’s test for qualitative variables. Results. LOS in ED was significatively reduced in the intervention group (180 ± 88 min vs 327 ± 122 min, p < 0.001). NRS reduction was higher in intervention group (1.6 +/- 4.1 vs 0.1 +/- 3.8, p = 0.043), while opioid consumption was similar between groups (p = 0.46). Rate of fatal complications (0% vs 6.9%, p = 0.039) and mortality (0% vs 8%, p = 0.02) were lower in the intervention group. Conclusion. An orthogeriatric fast-track pathway significantly reduces ED LOS and is associated with lower early mortality. Analgesia efficiency is positively impacted, whilst opioid consumption remains similar.