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Research Article
Varalak Srinonprasert
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes.
Methods: A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital pre- and post-implementation of the Fast-track program. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation.
Results: 302 patients were enrolled from the Siriraj hospital’s database between October 2016 and October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p<0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-hours (80.3% VS 44.7%, p<0.001) and the length of stay was significantly shorter (11 days (8-17) VS 13 days (9-18), p=0.017). There was no significant difference in medical complications and mortality. Stratified analysis by dementia status showed a trend in delirium reduction in both demented and non-demented groups, and a pressure injury reduction among patients with dementia after the program was implemented but there was no statistical significance.
Conclusions: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited settings. In the Fast-track system, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.
Keywords
hip fracture, orthogeriatric, elderly, dementia, delirium, complications, length of stay, mortality
Figure 1
No competing interests reported.
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A new preprint design is coming!
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Varalak Srinonprasert
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 02 Jun, 2021
No community comments so far
Editorial decision: Major revision
On 29 Jun, 2021
Reviews received
Received 17 Jun, 2021
Reviewers agreed
On 06 Jun, 2021
Reviewers agreed
On 01 Jun, 2021
Reviewers invited
Invitations sent on 01 Jun, 2021
Editor assigned
On 31 May, 2021
Editor invited
On 31 May, 2021
Submission checks complete
On 31 May, 2021
First submitted
On 20 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes.
Methods: A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital pre- and post-implementation of the Fast-track program. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation.
Results: 302 patients were enrolled from the Siriraj hospital’s database between October 2016 and October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p<0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-hours (80.3% VS 44.7%, p<0.001) and the length of stay was significantly shorter (11 days (8-17) VS 13 days (9-18), p=0.017). There was no significant difference in medical complications and mortality. Stratified analysis by dementia status showed a trend in delirium reduction in both demented and non-demented groups, and a pressure injury reduction among patients with dementia after the program was implemented but there was no statistical significance.
Conclusions: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited settings. In the Fast-track system, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.
Figure 1
No competing interests reported.
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