Accelerated operative recovery in elderly patients with femoral fractures: Our experience of ten years with 870 patients

Abstract

Background: The WHO considers elderly as an individual who is ≥ 60 y of age, and there are ≥ 37.7 million elderly people. In 2006, the ACERTO Project (Acceleration of Total Post-Operative Recovery) was introduced in Brazil in colorectal surgeries, and in elderly orthopedic femur fractures in 2010, with primary objective for the patient to early return to independent life. The objective of this descriptive study is to evaluate the clinical results 870 elderly patients undergoing surgical treatment of femoral fractures in ten years (2010-2019) after employing the perioperative acceleration protocol.
 Methodology: It was a cross-sectional, prospective study in patients ≥ 60 y, of both genders, undergoing corrective hip fracture for ten years at a hospital covered by the Brazilian Public Health System (SUS). The data regarding preoperative condition of the patients, fasting status, mode of anesthesia, drugs used, intra-operatively measured variables and immediate post-operative variables measured in the PACU, quality of lumbar plexus block analgesia, presence of delirium in the first day of postoperative was obtained from the study protocol. The deaths during the first postoperative month were noted.
 Results: A total of 829 patients underwent surgery for a fracture of the hip, under spinal anesthesia, of whom 583 were women and 246 were men. The average hospital stay was 10.2 ± 7.1 days, and it was associated with the age. The mean fasting time was 2:50 ± 0:32 h. The dose of isobaric bupivacaine was 9.62 ± 1:85 mg. The cephalad spread varied from T12 to T5. The duration of the spinal block was 2:50 ± 0:38 h, the time for the use of dextrinomaltose in PACU was 1:39 ± 0:47 h, the time in the PACU was 2:03 ± 0:46 h and the time to reintroduce normal meals was 6:18 ± 1:02 h. Arterial hypotension occurred in 36 (4.3%) patients, bradycardia in 4 (0.4%), and delirium in 16 patients. Eleven (1.3%) patients were sent to the ICU due to surgical problems. There were no deaths directly related to anesthesia or surgery.
 Conclusion: The implementation of the ACERTO Project in 829 patients with femur fracture of the Brazilian Public Health System, showed favorable results regarding length of stay, patient satisfaction, decreased use of bladder tube and drains, and referral to ICU, with early discharge to residence.
 Citation: Imbelloni LE, Teixeira DMP, Lima U, Ventura TB, Lacerda S, Brasileiro, Barbosa R, Sales MBL, Duarte M, Filho GBDM. Accelerated operative recovery in elderly patients with femoral fractures: Our experience of ten years with 870 patients. Anaesth. pain intensive care 2022;26(5):608-615; DOI: 10.35975/apic.v26i5.1992