A comprehensive hip fracture program reduces complication rates and mortality

Susanne Juhl Pedersen; Finn Borgbjerg Moltke; B. Schousboe; B.D. Pedersen; Henrik Løvendahl Jørgensen; Benn Rønnow Duus; Jes Bruun Lauritzen

doi:10.1111/j.1532-5415.2008.01945.x

A comprehensive hip fracture program reduces complication rates and mortality

Susanne Juhl Pedersen, Finn Borgbjerg Moltke, B. Schousboe, B.D. Pedersen, Henrik Løvendahl Jørgensen, Benn Rønnow Duus, Jes Bruun Lauritzen

Department of Clinical Medicine

119 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication Was reduced from 33% to 20% (odds ratio = 0.61, 95% confidence interval 0.4-0.9; P = .002). Rates of confusion (P = .02), pneumonia (P = .03), and urinary tract infection (P < .001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P < .001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality
Udgivelsesdato: 2008/10

Original language	English
Journal	Journal of the American Geriatrics Society
Volume	56
Issue number	10
Pages (from-to)	1831-1838
Number of pages	7
ISSN	0002-8614
DOIs	https://doi.org/10.1111/j.1532-5415.2008.01945.x
Publication status	Published - 2008

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10.1111/j.1532-5415.2008.01945.x

Cite this

@article{03898cb0065011deb05e000ea68e967b,

title = "A comprehensive hip fracture program reduces complication rates and mortality",

abstract = "OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication Was reduced from 33% to 20% (odds ratio = 0.61, 95% confidence interval 0.4-0.9; P = .002). Rates of confusion (P = .02), pneumonia (P = .03), and urinary tract infection (P < .001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P < .001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality Udgivelsesdato: 2008/10",

author = "Pedersen, {Susanne Juhl} and Moltke, {Finn Borgbjerg} and B. Schousboe and B.D. Pedersen and J{\o}rgensen, {Henrik L{\o}vendahl} and Duus, {Benn R{\o}nnow} and Lauritzen, {Jes Bruun}",

note = "Times Cited: 0ArticleEnglishJorgensen, H. LUniv Copenhagen, Dept Clin Biochem, Bispebjerg Hosp, Fac Hlth Sci, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, DenmarkCited References Count: 39358EOBLACKWELL PUBLISHING9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLANDOXFORD",

year = "2008",

doi = "10.1111/j.1532-5415.2008.01945.x",

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volume = "56",

pages = "1831--1838",

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TY - JOUR

T1 - A comprehensive hip fracture program reduces complication rates and mortality

AU - Pedersen, Susanne Juhl

AU - Moltke, Finn Borgbjerg

AU - Schousboe, B.

AU - Pedersen, B.D.

AU - Jørgensen, Henrik Løvendahl

AU - Duus, Benn Rønnow

AU - Lauritzen, Jes Bruun

N1 - Times Cited: 0ArticleEnglishJorgensen, H. LUniv Copenhagen, Dept Clin Biochem, Bispebjerg Hosp, Fac Hlth Sci, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, DenmarkCited References Count: 39358EOBLACKWELL PUBLISHING9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLANDOXFORD

PY - 2008

Y1 - 2008

N2 - OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication Was reduced from 33% to 20% (odds ratio = 0.61, 95% confidence interval 0.4-0.9; P = .002). Rates of confusion (P = .02), pneumonia (P = .03), and urinary tract infection (P < .001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P < .001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality Udgivelsesdato: 2008/10

AB - OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication Was reduced from 33% to 20% (odds ratio = 0.61, 95% confidence interval 0.4-0.9; P = .002). Rates of confusion (P = .02), pneumonia (P = .03), and urinary tract infection (P < .001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P < .001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality Udgivelsesdato: 2008/10

U2 - 10.1111/j.1532-5415.2008.01945.x

DO - 10.1111/j.1532-5415.2008.01945.x

M3 - Journal article

SN - 0002-8614

VL - 56

SP - 1831

EP - 1838

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

IS - 10

ER -