First Place Award Multidisciplinary care of the hip fracture patient: a case control analysis of differing treatment protocols

Background: Recent evidence has suggested that geriatric patients with osteoporotic hip fractures may benefit from comanagement with a multidisciplinary care team. We evaluated the effect that establishment of a comprehensive multidisciplinary care team had on time to surgery, length of hospital stay, postoperative complications, and morbidity on geriatric hip fracture patients. Methods: This study was a retrospective comparative cohort study of 267 patients admitted for geriatric hip fractures at an academic trauma center and a community hospital. Patients at the academic hospital were treated by a unilateral orthopaedic team, while patients at the community hospital were treated by a comprehensive multidisciplinary team (MDT), with both hospitals served by the same group of rotating physicians and ancillary staff. Outcomes included time to surgery (TTS), length of stay (LOS), postoperative complications, and mortality rates. Results: One hundred and twenty-nine hip fractures were treated by the MDT and 138 by the non-MDT. The MDT cohort was older (84.5 vs. 79.9 yr, P<0.001) and had a larger percentage of women (79.8% vs. 67.4%, P=0.03) than the non-MDT cohort. Patients in the MDT cohort experienced a shorter TTS (1.7 vs. 2.4 days, P<0.001) and LOS (8.2 vs. 10.7 days, P=0.024) than those in the non-MDT cohort. There were no differences in complication or mortality rates between the two cohorts. Conclusions: Treatment of patients with hip fractures by a comprehensive multidisciplinary team may lead to improved clinical processes shown by decreased time to surgery and shorter LOS but did not significantly decrease individual complication or mortality rates.