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

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, by allowing for early clinical assessment, rapid diagnostics and tailored analgesia by regional anaesthesia (RA) optimize perioperative management and 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 retrospective cohort took place in a Swiss ED and included patients aged ≥ 65 years with hip fractures, before and after fast-track implementation. Exclusion criteria were contraindication to or patient refusal of RA, inability to consent and polytrauma. The primary outcome was ED LOS. Secondary outcomes were analgesia efficiency in the ED (i.e., NRS reduction, cumulative opioid consumption), 72-hours complications rate and 30-day mortality. Wilcoxon rank sum test was used for quantitative variables and Fisher’s test for qualitative variables. RESULTS: A total of 152 patients were included, with 87 in the pre-implementation group and 65 in the post-implementation group. The post-intervention group had significantly shorter ED LOS (180 ± 88 min vs. 327 ± 122 min, p < 0.001) and experiences greater NRS reduction (1.6 +/- 4.1 vs. 0.1 +/- 3.8, p = 0.043), while opioid consumption did not differ 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; however no opioid sparing effect was observed.