Impact of a Multidisciplinary Algorithm on Early Complications After Hip Fracture Surgery: A Retrospective...

Area of Science:

• Geriatric Medicine
• Orthopedic Surgery
• Anesthesiology
• Public Health

Background:

• Hip fractures in the elderly are associated with high morbidity.
• Current management often focuses on isolated perioperative interventions.
• A coordinated multidisciplinary approach may offer superior outcomes.

Purpose of the Study:

• To evaluate the effectiveness of the Advise, Surgery, Analgesia, Pharmacology (ASAP) bundle in reducing early postoperative complications (EPOCs) within 7 days following hip fracture surgery.
• To assess the impact of a comprehensive perioperative algorithm on patient outcomes.

Main Methods:

• Retrospective, single-center interrupted time-series cohort study (January 2017-December 2022).
• Comparison of EPOC rates (Clavien-Dindo grades 1-4 and 2-4) between pre-ASAP and post-ASAP implementation periods.
• Interrupted time-series analysis, Kaplan-Meier curves, and Cox proportional hazards models were used.

Main Results:

• The ASAP bundle implementation led to an immediate and sustained reduction in all EPOCs (P = .032) and major EPOCs (P < .001).
• Post-ASAP, there was a significantly lower cumulative incidence of both all and major complications.
• The hazard for all EPOCs was reduced by 42% (HR, 0.58) and for major EPOCs by 40% (HR, 0.60).
• Early surgery and supra-inguinal fascia iliaca block (SFIB) independently predicted fewer complications.

Conclusions:

• The ASAP bundle is an effective multimodal strategy for reducing early postoperative complications in elderly hip fracture patients.
• Early surgical intervention and SFIB are critical components contributing to improved outcomes.
• This study supports the broader adoption of coordinated perioperative care algorithms for elderly patients with hip fractures.