The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

Abstract

BackgroundIntertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures.MethodsIn this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0.ResultsNo significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p < 0.001) and 48 h (80.9 vs. 63.5%, p < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p < 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality.ConclusionThe MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.

“Multidisciplinary fast-track” care can significantly reduce risk of mortality among hip fracture patients at least 80 years old: a single-center retrospective study

“…Previous work concurs with our finding of no clear benefit of MFT care on short-term survival [ 11 , 14 , 15 , 25 ]. This may reflect that the primary risk factors for mortality soon after hip fracture surgery are age, sex, and preoperative complications [ 9 , 26 ].…”

“…Our results support previous studies that found MFT care to shorten hospitalization and accelerate recovery among geriatric patients covering a wide age range from 60 years and older who underwent.hip fracture surgery [ 11 – 18 ]. At least in the present study, the advantages of MFT care are likely due in part to clinicians’ efforts to perform surgery within 72 h after admission.…”

“…Consensus guidelines [ 7 , 10 ] have begun recommending multidisciplinary collaborative diagnosis and perioperative management of hip fracture patients in order to accelerate surgical intervention and improve prognosis [ 11 – 18 ]. The term “multidisciplinary fast-track” (MFT) is often used to refer to the close cooperation of various clinical departments to diagnose, treat and rehabilitate patients after medical interventions [ 7 , 10 , 19 ].…”

Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

“…In addition, no significant differences were observed in postoperative mortality within 1 year between TXA group and control group. The main reasons of high mortality rate in the elderly patients with intertrochanteric fractures are various complications such as respiratory infection, lower extremity deep vein thrombosis, and pressure ulcers ( Fan et al, 2021 ). Our study demonstrated that the administration of TXA did not increase the risk of the complications.…”

Valoración preoperatoria y preparación para cirugía de cadera en el adulto mayor

“…Si el manejo definitivo propuesto es la cirugía, el paciente se encuentra estable y está de acuerdo con el manejo quirúrgico y los exámenes se encuentran en los rangos aceptados, entonces debe procederse con la cirugía lo antes posible, dentro de las primeras 24-48 horas (5,44,46). Solicitud de exámenes.…”