Abstract
BackgroundIntertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures.MethodsIn this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0.ResultsNo significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p < 0.001) and 48 h (80.9 vs. 63.5%, p < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p < 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality.ConclusionThe MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.
Highlights
The incidence of hip fractures is increasing quickly in recent years owing to the longer life expectancy and increasing number of elderly patients [1]
241 patients were included in the multidisciplinary team (MDT) group and 249 patients in the traditional orthopedic care (TOC) group
We found that the implementation of MDT co-management for elderly patients with an intertrochanteric fracture was associated with a reduced time-to-surgery, reduced LOS, and reduced postoperative complications
Summary
The incidence of hip fractures is increasing quickly in recent years owing to the longer life expectancy and increasing number of elderly patients [1]. One study demonstrated that surgery within 48 h of admission could significantly reduce the mortality risk in hip fracture patients [4]. Hip fractures generally occurred in elderly patients with multiple medical comorbidities, which could prolong the preoperative waiting time by assessing the medical comorbidities. Preoperative risk stratification and interventions tended to reduce postoperative complications and unplanned hospital readmissions in frail older patients [7]. Geriatric co-management has been rapidly emerging as a favored clinical care model for older patients with hip fractures, which could reduce the length-of-stay (LOS), mortality, postoperative complications, and unplanned hospital readmissions [8–10]. Geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures
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