The Introduction of a Multidisciplinary Hip Fracture Pathway to Optimise Patient Care and Reduce Mortality: A Prospective Audit of 161 Patients

Abstract

Introduction:Hip fractures are a major cause of morbidity and mortality in the elderly. A new patient pathway was introduced in our institution to facilitate rapid preoperative assessment, acute physician involvement and early surgery for patients with hip fractures. We sought to assess its impact on patient care and outcomes.Materials and Methods:Prospective audit of 161 patients admitted with a proximal femoral fracture in the six months before (92 patients) and after (69 patients) implementation of the pathway. Data included: time to orthogeriatric assessment (TtG); time to surgery (TtS); length of hospital stay (LOS); return to original accommodation; inpatient mortality rate.Results:In the six months after introduction of the pathway, there was an increase in patients who received pre-operative medical assessment (85% after vs. 19% before, p=0.0001). Average TtG decreased (19 vs. 91 hours, p=0.0001), as did LOS (19.5 vs. 24.8 days, p=0.029) and mortality (4 vs. 14%, p=0.0336). There was an increase in patients returning to their original place of accommodation (80% vs. 57%, p=0.0069). There was a reduction in mean TtS (31 vs. 37 hours, p=0.0663), although this was not statistically significant.Discussion and Conclusions:Rapid medical optimisation and prompt surgery significantly improve outcomes in patients with hip fractures. By involving an acute medical team in patient care from the point of admission, we have significantly improved our inpatient mortality and increased the proportion of patients returning to their preoperative place of accommodation, thereby maintaining patient independence and reducing the financial and logistical burden on social care.

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

“…Furthermore, decreased muscle strength and vitamin D deficiency in geriatric hip fracture patients were also reported to increase mortality rates in the Spanish FONDA cohort [ 22 ]. Therefore, a multi-disciplinary management approach [ 23 , 24 ] (by orthopedic surgeons, geriatricians, and fracture liaison nurses) is strongly advised to patients identified with these risks factors (in particular, pre-fracture mobility and previous medical conditions) in order to proactively work towards improving the survival rate after an intracapsular hip fracture event. More detailed investigation is suggested to dissect the relative risks in various medically compromised groups.…”

Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time

“…4 Ensuring access to the resolution of this pathology reduces health costs, increases survival, and improves the life quality of the patients. 5 Despite the importance of this pathology and several studies reporting mortality at 1 year since hip fracture, no long-term survival analysis has been published; therefore, the impact on long-term survival compared to the general population and the long-term effect of wait time for surgery are unknown.…”

Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series

“…47 Multidisciplinary approach with a pathway that mandated full medical evaluation with the aim to diagnose and correct reversible problems had resulted in reduced cancelation of surgery due to inadequate preoperative medical optimization and reduced mortality. 48 Such studies pointed to the importance of geriatric comanagement in caring for patients with hip fracture.…”