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Impact of a Multidisciplinary Algorithm on Early Complications After Hip Fracture Surgery: A Retrospective
Michele Carella1,2, Florian Beck1,3, Ambre Tanke1
1From the Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium.
Background:
Hip fracture carries high morbidity in elderly patients. While most efforts focus on single perioperative measures, we assessed whether a coordinated multidisciplinary algorithm could reduce early postoperative complications (EPOCs) within 7 days. The Advise, Surgery, Analgesia, Pharmacology (ASAP) bundle comprises four components: orthogeriatric consultation (Advise), surgery within 12 hours (Surgery), supra-inguinal fascia iliaca block (SFIB; Analgesia), and chronic therapy adjustment (Pharmacology).
Methods:
In this retrospective, single-center interrupted time-series cohort study (January 2017-December 2022), we compared hip fracture patients admitted pre-ASAP (January 1, 2017-December 31, 2019) versus post-ASAP (January 1, 2020-December 31, 2022). Following ethics approval, we conducted interrupted time-series analysis of 7-day EPOC rates, stratified by Clavien-Dindo grades: all complications (1-4) and major complications (2-4). Kaplan-Meier and Cox proportional hazards models evaluated cumulative incidence and hazard ratios (HRs).
Results:
Among 845 patients (480 pre-ASAP, 365 post-ASAP), all EPOCs declined immediately after ASAP implementation (P = .032) with a sustained negative trend over time (P = .008), and major EPOCs also decreased immediately (P < .001) with a flatter subsequent trend (P = .20). Kaplan-Meier curves confirmed a lower cumulative incidence of both all and major complications post-ASAP (log-rank P < .001). ASAP reduced the hazard for all EPOCs (HR, 0.58; 95% confidence interval [CI], 0.49-0.68) and major EPOCs (HR, 0.60; 95% CI, 0.49-0.73). Early surgery and SFIB each independently predicted fewer all EPOCs, whereas only early surgery predicted fewer major EPOCs.
Conclusions:
Implementation of the ASAP bundle significantly lowered EPOCs after hip fracture surgery. Early surgery and SFIB were especially impactful, supporting broader adoption of multimodal perioperative strategies in elderly patients.
