Key result
Implementation of a multidisciplinary shared care protocol reduced the composite risk of in-hospital mortality and/or prolonged hospital stay by 51% (adjusted OR 0.49) in elderly patients with hip fracture.
Why the study?
Hip fracture in geriatric patients causes significant morbidity, mortality, and cost, prompting evaluation of a multidisciplinary shared care protocol on hospital stay and in-hospital mortality.
Does a multidisciplinary shared care protocol reduce in-hospital mortality and/or prolonged hospital stay in patients aged 65 years or older operated for hip fracture?
Cohort (n=681)
No
Does a multidisciplinary shared care protocol reduce in-hospital mortality and/or prolonged hospital stay in patients aged 65 years or older operated for hip fracture?
Odds Ratio: 0.49 (95% CI 0.32–0.74)
Absolute Event Rate: 18.3% vs 31%
p-value: p=0.001
Implementing a multidisciplinary shared care protocol significantly reduced the risk of in-hospital mortality and prolonged hospital stay in elderly patients operated for hip fracture.
Supports multidisciplinary hip fracture care; hypothesis-generating and requires randomized confirmation before practice change.
Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.
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Marín et al. (2020) conducted a cohort in Hip fracture (n=681). Multidisciplinary shared care protocol vs. Standard care prior to protocol implementation (2011-2014) was evaluated on Composite of in-hospital mortality and/or hospital stay of more than 10 days (OR 0.49, 95% CI 0.32-0.74, p=0.001). Implementation of a multidisciplinary shared care protocol reduced the composite risk of in-hospital mortality and/or prolonged hospital stay by 51% (adjusted OR 0.49) in elderly patients with hip fracture.
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