In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team

Abstract

ObjectivesMedical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist.MethodsIn-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality.ResultsIn the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132).ConclusionsIdentification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.

Short-Term Outcomes of Interdisciplinary Hip Fracture Rehabilitation in Frail Elderly Inpatients

“…Hip fracture is one of the most common traumatic events which may occur among elderly people. The mean age for this cohort was 84 years old, older than in other recent studies [10, 11]. Older age did not seem to be a decisive factor to affect prefracture functional independence of patients (prefracture Barthel median 90).…”

Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

“…Other qualitative factors may have also contributed to the low incidence in our cohort. In the geriatrician‐led orthogeriatric team, patients were medically optimised on admission to minimise delay to surgery and post‐operative complications . There was dedicated dietician input for intensive nutritional support post‐operatively in the form of oral nutritional supplement drinks and enteral feeding where appropriate.…”

“…In the geriatrician-led orthogeriatric team, patients were medically optimised on admission to minimise delay to surgery and post-operative complications. [13][14][15][16] There was dedicated dietician input for intensive nutritional support post-operatively in the form of oral nutritional supplement drinks and enteral feeding where appropriate. In critical care patients and burns patients, enteral feeding has been shown as an effective strategy for gastrointestinal stress ulceration prevention and lowers the incidence of UGIB.…”

Perioperative Myocardial Infarction/Myocardial Injury Is Associated with High Hospital Mortality in Elderly Patients Undergoing Hip Fracture Surgery

“…All patients with hip fracture referred to AOU Careggi Firenze within a five-year period were eligible for the study. At hospital admission, they underwent multidisciplinary clinical evaluation, as previously reported [ 11 ]. ECG and laboratory examination including troponin I assay were performed at admission.…”

“…Patients undergoing hip surgery have a high incidence of myocardial injury, and troponin increase is associated with poor prognosis [ 8 , 9 , 10 ]. In our institution, patients undergoing hip surgery are followed by a multidisciplinary group [ 11 ]. This organization allows us to routinely perform post-operative ECG and echocardiogram; therefore, troponin changes can be related with clinical and/or objective evidence of myocardial ischemia, allowing for a distinction to be made between MI and myocardial injury.…”