The effect of a multidisciplinary approach on geriatric hip fractures in Japan

Shigemoto, Kazuhiro; Sawaguchi, Takahiro; Goshima, Kenichi; Iwai, Shintarou; Nakanishi, Akira; Ueoka, Ken

doi:10.1016/j.jos.2018.09.012

Cited by 25 publications

(20 citation statements)

References 15 publications

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“…Based on the logistic regression analysis, our results can be explained by more prompt surgery and internist intervention for comorbidities at the time of injury, which decreased the occurrence of new complications after admission and prevented existing comorbidities from worsening. Similar results have been observed in previous studies [10,[19][20][21]. Moreover, more patients were able to undergo hip surgery after FLS introduction at our hospital, possibly due to cooperation between orthopedic surgeons and internists.…”

Section: Discussionsupporting

confidence: 91%

“…In this study, we observed that 23.4% of patients among the control group experienced complications after admission; this rate was similar to the rates reported in previous research [3,10]. Contrastingly, complications decreased following admission among the FLS group.…”

Section: Discussionsupporting

confidence: 91%

“…To reduce the burden of consultation with internists, we based the consultation criteria on a report by Shigemoto et al [10] as well as information provided in Table 1. As recommended by several hip fracture management guidelines, we consulted with various specialists regarding early surgery (36 hours after the injury) based on the patient status, as shown in Table 1 [14][15][16][17].…”

Section: Fls Outlinementioning

confidence: 99%

“…Many models of fracture liaison services (FLS) that have been introduced in the United Kingdom [4][5][6][7][8][9] and Japan [10] have reduced the rate of medical complications and secondary fracture and improved the cost-effectiveness of the treatment [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…In our institution, we introduced FLS based on the methods implemented in Toyama, Japan [10]. As data on hip fracture outcomes following FLS introduction are scarce in Japan, our study investigated improvements in time to surgery, daily activity, and the rate of medical complications after admission and secondary hip fractures following the introduction of FLS.…”

Section: Introductionmentioning

confidence: 99%

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Fracture Liaison Service to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

Imai

Endo

Suda

et al. 2020

Preprint

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Background: Many models of fracture liaison services (FLS) following hip fracture have been introduced in the United Kingdom and Japan, resulting in a reduction in medical complications and secondary fractures. This study investigated improvements in time to surgery, daily activity, and the rate of medical complications and secondary hip fractures following the introduction of FLS.Methods: Patients who were over 50 years old and experienced fragility hip fractures, including femoral neck and trochanteric fractures, between January 1, 2015 and December 31, 2017, were enrolled in the study. We divided patients into a control group without FLS (94 patients; mean age: 83.8 years; 21 men and 73 women) and an FLS group (373 patients; mean age: 83.3 years; 69 men and 304 women).Results: The time from injury to surgery decreased significantly from 2.42 days to 1.83 days following the introduction of FLS (p = 0.003). The proportion of patients who were able to undergo surgery within 36 hours of injury also increased significantly in the FLS group (p = 0.014). In the FLS group, a significant decrease was observed in the total number of cases with complications, including cardiovascular disease, pulmonary disease, and cerebrovascular disease, after admission (p = 0.009, 0.010, 0.043, respectively). Significantly more patients with a Barthel index (BI) of ≥80 were observed in the FLS group at 6 months, 12 months, and 24 months following injury (p = 0.046, 0.018, and 0.048, respectively). Multiple logistic regression analysis revealed that BI at the time of injury, surgery within 36 hours of injury, and postoperative complications were associated with death within 12 or 24 months after the injury.Conclusions: Our results indicate that FLS contributed to earlier recovery and rehabilitation following surgery, and accelerated rehabilitation of medical complications following admission. Our FLS is expected to improve patient activity and decrease secondary hip fracture in patients who have undergone hip surgery. Trial registration: University Hospital Medical Information Clinical Trials Registry, UMIN000041206. Registered 24th July 2020, https://upload.umin.ac.jp/cgi-in/ctr/ctr_view_reg.cgi?recptno=R000047054

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Fls Outlinementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Fracture Liaison Service to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

Imai

Endo

Suda

et al. 2020

Preprint

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Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

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Pre- and Perioperative Management of Hip Fracture

Shigemoto

Sawaguchi

2021

Osteoporotic Fracture and Systemic Skeletal Disorders

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The effect of a multidisciplinary approach on geriatric hip fractures in Japan

Cited by 25 publications

References 15 publications

Fracture Liaison Service to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

Fracture Liaison Service to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Pre- and Perioperative Management of Hip Fracture

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