Outcomes evaluation after application of multidisciplinary protocol of shared hospital care in patients aged 65 years and older and operated for hip fracture

Abstract Purpose In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture. Methods Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes. Results The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels. Conclusion Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

Download Full-text

Outcomes Evaluation after Application of Multidisciplinary Protocol of Shared Hospital Care in Patients Aged 65 Years and Older and Operated for Hip Fracture

10.21203/rs.3.rs-19859/v1 ◽

2020 ◽

Author(s):

Jorge Salvador Marín ◽

Francisco Javier Ferrández Martinez ◽

José Miguel Seguí Ripoll ◽

José Antonio Quesada Rico ◽

Domingo Orozco Beltrán ◽

...

Keyword(s):

Hip Fracture ◽

Blood Transfusion ◽

Hospital Mortality ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Shared Care ◽

Exposed Group ◽

Unexposed Group ◽

Care Protocol ◽

Composite Risk

Abstract Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

Download Full-text

Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients

Scientific Reports ◽

10.1038/s41598-021-03415-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jorge Salvador-Marín ◽

Francisco Javier Ferrández-Martínez ◽

Cort D. Lawton ◽

Domingo Orozco-Beltrán ◽

Jose Fernando Martínez-López ◽

...

Keyword(s):

Hip Fracture ◽

Hospital Mortality ◽

Multivariable Analysis ◽

Hospital Costs ◽

Length Of Hospital Stay ◽

Multidisciplinary Care ◽

Exposed Group ◽

Composite Outcome ◽

Surgical Delay ◽

Care Protocol

AbstractTo 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.

Download Full-text

The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay

Journal of Academic Research in Medicine ◽

10.4274/jarem.galenos.2019.2076 ◽

2020 ◽

Vol 10 (1) ◽

pp. 82-87

Author(s):

Gülay Kır ◽

Mehmet Buget ◽

Kemalettin Koltka ◽

Mustafa Çağlar Kir ◽

Kamil Pembeci

Keyword(s):

Hip Fracture ◽

Hospital Mortality ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Timing Of Surgery ◽

Hip Fracture Surgery ◽

Anesthesia Technique ◽

The Impact ◽

Fracture Surgery

Download Full-text

THE EFFECT OF BLOOD TRANSFUSION AND TRANEXAMIC ACID ON LENGTH OF HOSPITAL STAY AND MORTALITY AFTER HIP FRACTURE SURGERY IN ELDERLY PATIENTS

The Turkish Journal of Geriatrics ◽

10.31086/tjgeri.2020.172 ◽

2020 ◽

Vol 23 (3) ◽

pp. 353-361

Author(s):

Mutlu AKDOĞAN ◽

Halis Atıl ATİLLA

Keyword(s):

Hip Fracture ◽

Blood Transfusion ◽

Elderly Patients ◽

Tranexamic Acid ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Hip Fracture Surgery ◽

Fracture Surgery ◽

Surgery In Elderly

Download Full-text

Predictors of Length of Hospital Stay in Elderly Hip Fracture Patients

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2013.0160 ◽

2013 ◽

Vol 22 (02) ◽

pp. 160-163 ◽

Cited By ~ 14

Author(s):

Christopher A. Brown ◽

Steven Olson ◽

Robert Zura

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Length Of Hospital Stay

Download Full-text

The independent patient factors that affect length of stay following hip fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0068 ◽

2018 ◽

Vol 100 (7) ◽

pp. 556-562 ◽

Cited By ~ 4

Author(s):

T Richards ◽

A Glendenning ◽

D Benson ◽

S Alexander ◽

S Thati

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hospital Stay ◽

Hip Fractures ◽

Length Of Hospital Stay ◽

Hospital Length ◽

Acute Hospital ◽

Hospital Length Of Stay ◽

Patient Factors ◽

Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

Download Full-text

Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

Revista Española de Cirugía Ortopédica y Traumatología (English Edition) ◽

10.1016/j.recote.2021.05.009 ◽

2021 ◽

Vol 65 (5) ◽

pp. 322-330

Author(s):

J. Salvador Marín ◽

F.J. Ferrández Martínez ◽

C. Fuster Such ◽

J.M. Seguí Ripoll ◽

D. Orozco Beltrán ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Hospital Stay ◽

Hip Fractures ◽

Length Of Hospital Stay ◽

The Elderly ◽

High Length

Download Full-text

Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Critical Care ◽

10.1186/s13054-021-03762-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Taro Imaeda ◽

Taka-aki Nakada ◽

Nozomi Takahashi ◽

Yasuo Yamao ◽

Satoshi Nakagawa ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Hospital Stay ◽

Organ Dysfunction ◽

Length Of Hospital Stay ◽

Annual Incidence ◽

Claim Database ◽

Antibiotic Administration ◽

Electronic Health Record Data ◽

Acute Organ Dysfunction

Abstract Background Trends in the incidence and outcomes of sepsis using a Japanese nationwide database were investigated. Methods This was a retrospective cohort study. Adult patients, who had both presumed serious infections and acute organ dysfunction, between 2010 and 2017 were extracted using a combined method of administrative and electronic health record data from the Japanese nationwide medical claim database, which covered 71.5% of all acute care hospitals in 2017. Presumed serious infection was defined using blood culture test records and antibiotic administration. Acute organ dysfunction was defined using records of diagnosis according to the international statistical classification of diseases and related health problems, 10th revision, and records of organ support. The primary outcomes were the annual incidence of sepsis and death in sepsis per 1000 inpatients. The secondary outcomes were in-hospital mortality rate and length of hospital stay in patients with sepsis. Results The analyzed dataset included 50,490,128 adult inpatients admitted between 2010 and 2017. Of these, 2,043,073 (4.0%) patients had sepsis. During the 8-year period, the annual proportion of patients with sepsis across inpatients significantly increased (slope = + 0.30%/year, P < 0.0001), accounting for 4.9% of the total inpatients in 2017. The annual death rate of sepsis per 1000 inpatients significantly increased (slope = + 1.8/1000 inpatients year, P = 0.0001), accounting for 7.8 deaths per 1000 inpatients in 2017. The in-hospital mortality rate and median (interquartile range) length of hospital stay significantly decreased (P < 0.001) over the study period and were 18.3% and 27 (15–50) days in 2017, respectively. Conclusions The Japanese nationwide data indicate that the annual incidence of sepsis and death in inpatients with sepsis significantly increased; however, the annual mortality rates and length of hospital stay in patients with sepsis significantly decreased. The increasing incidence of sepsis and death in sepsis appear to be a significant and ongoing issue.

Download Full-text