Effects of fast track co-management care model on perioperative neurocognitive disorders in older patients undergoing hip fracture surgery: a multicenter retrospective cohort study

Background: This paper attempts to compare the effect of a co-management care model with a traditional orthopedic model on perioperative neurocognitive disorders complications in elderly hip fracture patients. Methods: In this study, elderly hip fracture patients attending six hospitals in Beijing from November 31, 2018 to November 31, 2020 were divided into co-management care model and traditional orthopedic model according to the intention-to-treat principle. Beijing Jishuitan Hospital implemented a rapid co-management care model (OGC group), and five Beijing hospitals, including Beijing Anzhen Hospital, implemented a traditional orthopedic model (TOC group). The study used the Confusion Assessment Method (CAM) and a modified telephone interview method targeting patients' cognitive status to assess the incidence of delirium in elderly patients. Results: A total of 2071 elderly hip surgery patients were included in the study, excluding 128 patients who received conservative treatment and 119 patients who were withdrawn from follow-up. Ultimately, 995 patients in the OGC group and 829 patients in the TOC group were included in the follow-up analysis. The incidence of perioperative neurocognitive disorders was significantly lower in the OGC group than in the TOC group (20.5% vs 69.5%, OR 0.59, 95% CI:0.53~0.65, P=0.000); the incidence of preoperative delirium was significantly lower in the OGC group than in the TOC group (10.5% vs 16.9%, OR 0.64, 95% CI:0.47-0.70, P=0.000); the incidence of postoperative delirium was also lower in the OGC group than in the TOC group (19.1% vs. 22.6%, OR 0.67, 95% CI:0.58 ~ 0.77, =0.001). Our logistic multivariate analysis also showed that the rapid fast-track co-management care model may be a protective factor against the development of neurocognitive impairment in patients in the perioperative period. Conclusion: The fast-track co-management care model can reduce the occurrence of perioperative neurocognitive disorders in elderly patients, which is worth being promoted in clinical treatment.