Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings

Unchana Sura-Amonrattana; Theerawoot Tharmviboonsri; Aasis Unnanuntana; Direk Tantigate; Varalak Srinonprasert

doi:10.1186/s12877-021-02509-y

Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings

BMC Geriatr. 2021 Oct 12;21(1):548. doi: 10.1186/s12877-021-02509-y.

Authors

Unchana Sura-Amonrattana¹, Theerawoot Tharmviboonsri², Aasis Unnanuntana², Direk Tantigate², Varalak Srinonprasert³

Affiliations

¹ Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. varalaksi@gmail.com.

Abstract

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 before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. 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: Three hundred two patients were enrolled from the Siriraj hospital's database from October 2016 to 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-h (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. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality.

Conclusions: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, 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: Complications; Delirium; Dementia; Elderly; Hip fracture; Length of stay; Mortality; Orthogeriatric.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Hip Fractures* / diagnosis
Hip Fractures* / epidemiology
Hip Fractures* / surgery
Hospital Mortality
Hospitalization
Hospitals, University
Humans
Length of Stay
Retrospective Studies