Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients
Por:
Salvador-Marín J, Ferrández-Martínez FJ, Lawton CD, Orozco D, Martínez-López JF, Kelly BT and Marzo-Campos JC
Publicada:
16 dic 2021
Ahead of Print:
16 dic 2021
Categoría:
Multidisciplinary
Resumen:
To 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.
Filiaciones:
:
Orthopedic Surgery and Traumatology Service, Sant Joan d'Alacant University Hospital, Alicante, Spain
:
Orthopedic Surgery and Traumatology Service, Sant Joan d'Alacant University Hospital, Alicante, Spain
Lawton CD:
Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
Orozco D:
Department of Clinical Medicine, Miguel Hernández University, Elche, Spain.
:
Orthopedic Surgery and Traumatology Service, Sant Joan d'Alacant University Hospital, Alicante, Spain
Kelly BT:
Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
:
Department of Health Psychology, Miguel Hernandez University, Elche, Spain
Green Published, gold
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