Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings

Unchana Sura-Amonrattana,Aasis Unnanuntana,Varalak Srinonprasert,Direk Tantigate,Theerawoot Tharmviboonsri

doi:10.1186/s12877-021-02509-y

Unchana Sura-Amonrattana, Aasis Unnanuntana + Show 3 more

Open Access

https://doi.org/10.1186/s12877-021-02509-y

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Journal: BMC Geriatrics	Publication Date: Oct 12, 2021
Citations: 5	License type: open-access

Affiliation: Siriraj Hospital, Mahidol University

Abstract

BackgroundHip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes.MethodsA retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation.ResultsThree hundred two patients were enrolled from the Siriraj hospital’s database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p < 0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-h (80.3% VS 44.7%, p < 0.001) and the length of stay was significantly shorter (11 days (8–17) VS 13 days (9–18), p = 0.017). There was no significant difference in medical complications. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality.ConclusionsThe implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.

Highlights

Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death
More than 4.5 million patients per year suffer from medical complications due to improper management of hip fractures
Most hip fractures are more likely to occur in frail older people with several geriatric syndromes such as functional impairment, malnutrition and dementia [8, 9]

Summary

Introduction

Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Older age, and multiple comorbidities are associated with an increased risk of death within the first year after a hip fracture [7]. Most hip fractures are more likely to occur in frail older people with several geriatric syndromes such as functional impairment, malnutrition and dementia [8, 9]. Those patients with complex medical comorbidities require more attention prior to undergoing operation. Multiple studies [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26] have reported that factors such as proper care at presentation, optimal pain control, an orthogeriatric model of care, comprehensive geriatric assessment (CGA), expedited time to surgery and early rehabilitation are associated with a lower risk of complications and decreased mortality in older patients with hip fractures

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