In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team
Open Access
- 7 July 2016
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 11 (7), e0158607
- https://doi.org/10.1371/journal.pone.0158607
Abstract
Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.Funding Information
- Italian Health Ministry and Regione Toscana (D11J12000380003)
This publication has 21 references indexed in Scilit:
- Multidisciplinary Approach to Hip Fracture in the Elderly: Florence ExperienceEmergency Medicine: Open Access, 2013
- Does pre-operative echocardiography delay hip fracture surgery?Indian Journal of Anaesthesia, 2013
- Bias towards dementia: Are hip fracture trials excluding too many patients? A systematic reviewInjury, 2012
- Comparing hospital mortality – how to count does matter for patients hospitalized for acute myocardial infarction (AMI), stroke and hip fractureBMC Health Services Research, 2012
- Mortality rates after surgery in New South WalesAnz Journal of Surgery, 2012
- Diabetes and Health Outcomes Among Older Taiwanese with Hip FractureRejuvenation Research, 2012
- Pre‐operative echocardiography for hip fractures: time to make it a standard of careAnaesthesia, 2012
- Impact of heart failure on hip fracture outcomes: A population‐based studyJournal of Hospital Medicine, 2011
- Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regressionCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008
- Fracture and Dislocation Classification Compendium - 2007Journal of Orthopaedic Trauma, 2007