Preoperative Optimization of Geriatric Hip Fractures Using a Detailed Multidisciplinary Protocol - Abstract
Objective: To compare morbidity, mortality and institutional costs for hip fracture patients after implementation of an interdisciplinary protocol to expedite
preoperative optimization at our institution.
Design: Single center, prospective cohort study.
Setting: Single tertiary medical center.
Patients: This study included patients with diagnosed hip fractures age 65 and older in both pilot (26 patients) and pre-pilot (43 patients) cohorts requiring
surgical intervention who met inclusion and exclusion criteria.
Intervention: An interdisciplinary protocol was implemented for preoperative optimization of patients requiring surgical fixation of hip fractures which
included standardized preoperative labs, tests and a pre-determined maximum time allotted for evaluating patients by consulting services.
Outcome Measurements: Primary outcomes assessed included in-hospital mortality, 30-day and 90-day mortality. Secondary outcomes included adverse
patient events, 30 and 90-day readmissions, postoperative ICU admissions and institutional costs per admission.
Results: In the pilot group, there were statistically significant decreases in 90-day mortality, 30-day readmission rates and ICU admissions. A 26.1%
decrease in average direct cost to the hospital per patient was observed between Pre-pilot ($16,775.65) and Pilot ($12,397.22) groups.
Conclusion: This study outlines the importance of a detailed protocol to expedite surgical intervention. It demonstrates effectiveness of patient outcomes
for treatment of hip fractures in a patient population with average comorbidity index scores higher than similar studies. Protocol implementation also resulted
in a dramatic decrease in overall costs at our institution, which is important as our current medico-economic environment focuses on minimizing excessive medical
expenditures nationwide.
Level of Evidence: II