Key result
Daily post-operative rounds by anaesthesiologists reduced requested visits from internal medicine specialists (P=0.02), but did not significantly reduce in-hospital mortality (7% vs 12%, P=0.24).
Why the study?
Efforts to optimize peri-operative care of hip fracture patients through orthopaedic-geriatric liaisons have not resulted in significant outcome changes, prompting evaluation of anaesthesiologist involvement.
Do daily post-operative rounds by anaesthesiologists reduce morbidity and the need for external specialist visits in community-residing patients after hip fracture surgery?
Cohort (n=224)
Do daily post-operative rounds by anaesthesiologists reduce morbidity and the need for external specialist visits in community-residing patients after hip fracture surgery?
Post-operative rounds by anaesthesiologists after hip fracture surgery reduced the need for internal medicine specialist consultations but did not significantly improve morbidity or mortality in this underpowered pilot study.
Answers are grounded in this paper and cite their sources.
Reduced internal medicine consultations after hip fracture surgery without lowering mortality; leaves open benefit in adequately powered trials.
BACKGROUND: Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing on all facets of peri-operative care. Two hours were allotted to rounds in the 14-bed unit. One hundred and twenty-six consecutive patients admitted to the unit in 2003, receiving the same well-defined care programme, were chosen as a control group. Outcome measures were morbidity and the need for visits by external specialists. RESULTS: The intervention group received 291 rounds by anaesthesiologists. Active therapeutic interventions were prescribed in 76% of all patient confrontations. The control group received 128 requested visits from internal medicine specialists, which was reduced to 50 in the intervention group (P = 0.02). There was no significant difference between post-operative morbidity and hospital stay in the control and intervention groups; in-hospital mortality was 12% in the control group and 7% in the intervention group (P = 0.24). The rounds by anaesthesiologists improved nursing care conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome aspects, providing anaesthesiological rounds 7 days per week.
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Foss et al. (2006) conducted a cohort in Hip fracture (n=224). Daily post-operative rounds by anaesthesiologists vs. Standard care (historical control from 2003) was evaluated on In-hospital mortality (p=0.24). Daily post-operative rounds by anaesthesiologists reduced requested visits from internal medicine specialists (P=0.02), but did not significantly reduce in-hospital mortality (7% vs 12%, P=0.24).
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