Abstract
IntroductionOver 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures.MethodsWe performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation.ResultsWe studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001) than patients in the pre-GFP period.ConclusionImplementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.
Highlights
Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually
We studied 131 patients in the pre-geriatric fracture programs (GFP) period and 177 patients in the post-GFP period
In the post-GFP period, more patients received fascia iliaca compartment block (FICB) (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45-63%; p
Summary
Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Multidisciplinary geriatric fracture programs (GFP) reduce mortality,[9] morbidity,[9,10,11] and hospital costs.[12] GFP interventions include early multimodal pain management,[13] delirium prevention,[14] management of medical co-morbidities,[13,14] early operative fixation,[15,16] early mobilization,[17] and early discharge planning.[10,11,17] Many GFPs include preoperative regional
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