The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

Abstract

Background: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. Methods: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. Results: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. Conclusion: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability.

How well are we managing fragility hip fractures? A narrative report on the review with the attempt to setup a Fragility Fracture Registry in Hong Kong

“…10 There were 1257 (46.6%) femoral neck fractures, 1445 (49.6%) intertrochanteric fractures, and 110 (3.8%) subtrochanteric fractures, comparable with a previous local study of 1342 hip fracture patients from 2007 to 2010. 8 The majority of patients had an ASA score of 2 and 3, comprising 40.9% and 56.3%, respectively and in line with Lau et al's study. 8 There was a marked increase in hemiarthroplasties and intramedullary fixations with 977 (33.5%) and 983 (3.7%) cases respectively in our study, compared with Lau et al's study that reported 362 (27%) hemiarthroplasties and 218 (16%) cephalomedullary nail fixations.…”

“…8 The majority of patients had an ASA score of 2 and 3, comprising 40.9% and 56.3%, respectively and in line with Lau et al's study. 8 There was a marked increase in hemiarthroplasties and intramedullary fixations with 977 (33.5%) and 983 (3.7%) cases respectively in our study, compared with Lau et al's study that reported 362 (27%) hemiarthroplasties and 218 (16%) cephalomedullary nail fixations. 8 This reflects a change in the surgical treatment, possibly due to a lower re-operation rate, 11 better functional outcomes, 12 and higher cost-effectiveness 13 in patients treated with hemiarthroplasty; and minimal rate of fixation failure, less blood loss, and shorter length of hospital stay in patients treated with intramedullary fixation.…”

“…8 There was a marked increase in hemiarthroplasties and intramedullary fixations with 977 (33.5%) and 983 (3.7%) cases respectively in our study, compared with Lau et al's study that reported 362 (27%) hemiarthroplasties and 218 (16%) cephalomedullary nail fixations. 8 This reflects a change in the surgical treatment, possibly due to a lower re-operation rate, 11 better functional outcomes, 12 and higher cost-effectiveness 13 in patients treated with hemiarthroplasty; and minimal rate of fixation failure, less blood loss, and shorter length of hospital stay in patients treated with intramedullary fixation. 14 A low complication rate (6.0%) and revision rate (3.1%) are testimony to the improved standard of routine acute care, which includes early orthopaedic care and early surgeries.…”

“…1 The female-to-male ratio was around 2:1 indicating an increase in male fragility hip fractures compared with 2.5:1 from 2001 to 2010. 4,8 This may be due to increasing life expectancy of the HK male population 9 and bone mineral density (BMD) at the hip in men that decreases with age. 10 There were 1257 (46.6%) femoral neck fractures, 1445 (49.6%) intertrochanteric fractures, and 110 (3.8%) subtrochanteric fractures, comparable with a previous local study of 1342 hip fracture patients from 2007 to 2010.…”

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

“…Literature on effects of clinical pathways for hip fractures generally shows positive results, although some publication bias cannot be excluded [10][11][12][13]. A recent review by Leigheb et al showed similar reductions in the hospital length of stay in eight out of 12 studies [6].…”