Outcomes of Fast-Track Multidisciplinary Care of Hip Fractures in Veterans: A Geriatric Hip Fracture Program Report

Abstract

BackgroundHip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India.MethodsA total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year.ResultsThe average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up.ConclusionsElderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.

What is the impact of a fast-track pathway on length of stay for adult patients with a hip fracture? A systematic review

“…As only the abstract of both studies was available, these studies were excluded from the review. A further 20 articles were excluded as they did not meet the inclusion criteria (excluded articles n = 22) The main reasons for exclusion include, no comparator (n = 2) [25,26]; literature review (n = 1) [27]; audit (n = 4) [28][29][30][31]; incorrect participants (n = 1) [32] and inappropriate intervention (n = 12) [33][34][35][36][37][38][39][40][41][42][43][44]. Seven studies were considered suitable and included in this review.…”

Allogeneic Red Blood Cell Transfusion Rate and Risk Factors After Hemiarthroplasty in Elderly Patients With Femoral Neck Fracture

“…Millions of elderly people worldwide suffer from hip fractures each year due to minor accidents or falls ( Mitchell et al, 2017 ), and they are a common reason for the hospitalization of the elderly. Compared with other types of fracture, the incidence of hip fracture in the elderly is high, the mortality rate is high, and patients are prone to losing their independence ( Kulshrestha et al, 2019 ). Treatment methods involve surgery, which can reduce bed time, get patients out of bed as soon as possible, and reduce bed-ridden complications.…”

Metabolic activities affect femur and lumbar vertebrae remodeling, and anti-resorptive risedronate disturbs femoral cortical bone remodeling

“…Bone remodeling is achieved through a delicate balance between old bone resorption by osteoclasts and new bone formation by osteoblasts 1 . Bone mass and quality progressively decrease during aging because bone destruction exceeds bone formation, resulting in fragility fractures in older adults 2 , and osteoporotic fractures in the geriatric population are emerging as a major health problem 3 , 4 . In particular, postmenopausal women older than 65 years with estrogen deficiency frequently experience osteoporotic fractures of the hip, pelvis, wrist, humerus, vertebra, and cervical and intertrochanteric femurs 5 .…”