Abstract
To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48–0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.
Highlights
To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years
The aim of this study is to assess the impact of a multidisciplinary care protocol on the LOS, in-hospital mortality rate, and total hospitalization cost in patients aged 65 years or older who were operatively treated for a hip fracture
Exclusion criteria were: conservative treatment of a hip fracture; pathological fracture; polytrauma; bilateral hip fracture; and contralateral hip fracture because according to Sawalha et al and Liu et al, repeated hip fractures are associated with higher mortality, comorbidities and greater dependency compared to the first episode[17,18]
Summary
To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients. In Spain, the mean length of hospital stay (LOS) for hip fracture patient is 11.8 days, and the average total cost of the first admission for hip fracture management is EUR 5096.30. In addition to the cost increase, a hospital stay of more than 10 days, frequently as a result of medical complications, has been associated with an increase in mortality in the first month post-fracture, making LOS greater than 10 days a poor prognostic factor and a good indicator for evaluating the hip fracture care process[8].
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