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Improved outcomes following implementation of a multidisciplinary care pathway for elderly hip fractures
Raina Wallace1, L D George Angus2, Swapna Munnangi2
1Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, New York, NY, 11554, USA. rwallace@numc.edu.
Background:
Hip fractures in patients 65 years and older are associated with significant morbidity and mortality. With the steady increase in the elderly population, we implemented an evidence-based clinical practice guideline for the management of hip fractures to optimize patient care and surgical outcomes.
Aims:
To evaluate the effects of a multidisciplinary hip fracture care pathway on patient outcomes in the care of elderly patients.
Methods:
A retrospective analysis of the differences in outcomes prior to (January-October 2014) and after (November 2014-April 2016) implementation of a hip fracture care pathway at a regional Level I trauma center was performed.
Results:
There were 80 patients in the pre-pathway group and 191 patients in the post-pathway group with an average age of 83.18 ± 8.24 years. The analysis demonstrated that the post-pathway group had a lower incidence of in-hospital complications (9.95 vs 30.00%; p ≤ 0.001), shorter emergency room length of stay (3.76 ± 2.43 vs 6.78 ± 2.88 h; p ≤ 0.0001), and shorter overall hospital length of stay (5.03 ± 3.46 vs 7.44 ± 6.66 days; p = 0.0028). The in-hospital mortality rate was similar between groups (4.71 vs 6.25%; p = 0.6018).
Discussion:
The development of a multidisciplinary approach to the care of elderly patients with hip fractures improved morbidity and showed a downward trend in mortality.
Conclusions:
Elderly patients with hip fractures treated at our trauma center had improved clinical outcomes after the implementation of a multidisciplinary care pathway.
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