Key result
Application of a multidisciplinary team model significantly reduced overall complications to 16.5% compared to 31.3% with usual care in elderly patients with femoral neck fractures.
Why the study?
Femoral neck fractures carry substantial morbidity and mortality in older adults with multi-system comorbidities, which may benefit from a multidisciplinary team model.
Does a multidisciplinary team model reduce complications and improve outcomes in elderly patients with femoral neck fractures compared to usual care?
Cohort (n=199)
Unblinded
No
Does a multidisciplinary team model reduce complications and improve outcomes in elderly patients with femoral neck fractures compared to usual care?
Absolute Event Rate: 16.5% vs 31.3%
p-value: p=0.039
A multidisciplinary team approach for elderly patients with femoral neck fractures significantly reduces time to surgery, length of hospital stay, and postoperative complications compared to usual care.
Supports multidisciplinary teams for elderly femoral neck fractures; hypothesis-generating and requires RCTs before practice change.
BACKGROUND: Femoral neck fractures are associated with substantial morbidity and mortality for older adults. Multi-system medical diseases and complications can lead to long-term care needs, functional decline and death, so patients sustaining hip fractures usually have comorbid conditions that may benefit from application of multidisciplinary team(MDT). METHODS: This is a retrospective cohort study that incorporates medical record review with an outcomes management database. 199 patients were included who had surgery for a new unilateral femoral neck fracture from January 2018 to December 2021 (96 patients in usual care (UC) model and 103 patients in MDT model. High-energy, pathological, old and periprosthetic femoral neck fracture were excluded. Age, gender, comorbidity status, time to surgery, and postoperative complication, length of stay, in-hospital mortality, 30-day readmission rate, 90-day mortality data were collected and analyzed. RESULTS: Preoperative general data of sex, age, community dwelling and charlson comorbidity score of MDT group (n = 103) have no statistically significant difference with that of usual care (UC) group. Patients treated in the MDT model had significantly shorter times to surgery (38.5 vs. 73.4 h;P = 0.028) and lower lengths of stay (11.5 vs. 15.2 days;P = 0.031). There were no significant differences between two models in In-hospital mortality (1.0% vs. 2.1%; P = 0.273), 30-day readmission rate (7.8% vs. 11.5%; P = 0.352) and 90-day mortality (2.9% vs. 3.1%; P = 0.782). The MDT model had fewer complications overall (16.5% vs. 31.3%; P = 0.039), with significantly lower risks of delirium, postoperative infection, bleeding, cardiac complication, hypoxia, and thromboembolism. CONCLUSION: Application of MDT can provide standardized protocols and a total quality management approach, leading to fewer complications for elderly patients with femoral neck fracture. TRIAL REGISTRATION: No.
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Liang et al. (2023) conducted a cohort in Femoral neck fracture (n=199). Multidisciplinary team (MDT) model vs. Usual care (UC) model was evaluated on Overall complications (p=0.039). Application of a multidisciplinary team model significantly reduced overall complications to 16.5% compared to 31.3% with usual care in elderly patients with femoral neck fractures.
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