Abstract
IntroductionHip fracture surgery is among the most performed surgical procedures in elderly patients. Mortality rates are high, however, and patients often fail to live independently following a hip fracture. To improve outcome, multidisciplinary care pathways have been initiated, but longer-term results are lacking. Aim of this study was to compare functional outcome and living situation six months after hip fracture treatment with and without a care pathway. Patients and methodsA multicentre prospective controlled trial was conducted with three hospitals: in one hospital patients were treated with a care pathway, in the other hospitals patients received usual care. All patients aged ≥ 60 years with a hip fracture were asked to participate. Besides basic characteristics, health-related quality of life (EQ-5D) and performance scores of activities of daily living (Katz Index and Lawton IADL) were assessed. Differences in scores were analysed using linear regression. Propensity score adjustment was used to correct for differences between the care pathway and the usual care group. Missing data were imputed. ResultsNo differences in rate of return to prefracture ADL level were found between patients in the care pathway group and the usual care group. The percentage of participants in the same situation as before the fracture was the same in both treatment groups (81%). There were no significant differences in quality of life, activities of daily living or mortality (15% vs 10%, p = 0.17), but hospital stay in the care pathway group was significantly shorter (median 7 vs 10 days). DiscussionTreatment of elderly patients with a hip fracture is commonly organised in care pathways. Although short-term advantages are reported, positive effects on longer-term functional results could not be proven in our study. This study confirmed a shorter hospital stay in the care pathway group, which potentially may lead to a reduction in costs. ConclusionsFunctional outcome and living situation six months after a hip fracture is the same for patients treated with or without a care pathway.
Highlights
Hip fracture surgery is among the most performed surgical procedures in elderly patients
The aim of this study was to investigate the functional outcome and living situation of elderly patients after a hip fracture, following a comprehensive care pathway compared to usual care
This study found no differences in rate of return to prefracture activities of daily living (ADL) functioning levels between patients treated with a comprehensive care pathway and patients treated with usual care six months after surgical treatment of a hip fracture
Summary
Hip fracture surgery is among the most performed surgical procedures in elderly patients. Serious is the one-year mortality after hip fracture, which is around 30% [3] To cope with this growing epidemic, multidisciplinary care pathways and orthogeriatric units have been initiated in recent decades in order to improve outcomes for patients and reduce this economic burden [4]. The extent of these pathways varies, ranging between a single consultation with a geriatrician to full comprehensive care pathways, describing the care for these patients from arrival at the emergency room until the end of rehabilitation, with involvement of various care professionals. Hospital stay and postoperative mortality are often reduced [12,13,14,15,16,17]
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