Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture
We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality. A non-randomized intervention study with a historical control group (CG). During the hospit...
Gespeichert in:
| Veröffentlicht in: | Journal of clinical anesthesia 2019-03, Vol.53, p.11-19 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 19 |
|---|---|
| container_issue | |
| container_start_page | 11 |
| container_title | Journal of clinical anesthesia |
| container_volume | 53 |
| creator | Reguant, F. Arnau, A. Lorente, J.V. Maestro, L. Bosch, J. |
| description | We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.
A non-randomized intervention study with a historical control group (CG).
During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.
240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).
CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.
The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.
512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p |
| doi_str_mv | 10.1016/j.jclinane.2018.09.029 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2116850831</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0952818018307621</els_id><sourcerecordid>2116850831</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-b1c64519698e5d34762153178f3bcd78ba591d2bd025ba8a379ed98d472310c3</originalsourceid><addsrcrecordid>eNqFkUtr3TAQRkVpaW7T_oUg6KYbu3r4Ie1aQvqAQDfZC1kac2V8LVeSE-6_75ibdNFNV2LQmU-aOYTccFZzxrvPUz25OSx2gVowrmqmayb0K3LgqpdV0wr9mhyYbkWluGJX5F3OE2MML_hbciWZUJ1U7ECe7sYxOOvONI7U0tM2l-BDdmHd09OZ2nVN0bojjQtdYy5xhWRLeAR6imlAtiCz-L0qdt4rDILZQ5rPdEUSlpLpUyhHegwrHZN1ZUvwnrwZ7Zzhw_N5TR6-3T3c_qjuf33_efv1vnJSd6UauOualutOK2i9bPpO8FbyXo1ycL5Xg20192LwTLSDVVb2GrxWvumF5MzJa_LpEotD_N4gF3PC4WCecXFxy0Zw3qmWKckR_fgPOsUtLfg5pBBoOgxHqrtQLsWcE4xmTeGEizKcmd2MmcyLGbObMUwbNIONN8_x23AC_7ftRQUCXy4A4DoeAySDFmBx4EMCV4yP4X9v_AE_eqQv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2183146379</pqid></control><display><type>article</type><title>Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture</title><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Reguant, F. ; Arnau, A. ; Lorente, J.V. ; Maestro, L. ; Bosch, J.</creator><creatorcontrib>Reguant, F. ; Arnau, A. ; Lorente, J.V. ; Maestro, L. ; Bosch, J.</creatorcontrib><description>We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.
A non-randomized intervention study with a historical control group (CG).
During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.
240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).
CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.
The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.
512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42–0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44–0.93) were the protective factors for mortality.
The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
•Hip fracture is associated with high morbi-mortality in elderly patients.•A multidisciplinary approach could be reduced postoperative complications and hospital stay.•Surgical delay may not be associated with higher mortality rates.•Main objective of comprehensive care should be to optimize patient's health status.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2018.09.029</identifier><identifier>PMID: 30286380</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anemia ; Anticoagulants ; Clinical pathway ; Comorbidity ; Consent ; Ethics ; Fractures ; Hemoglobin ; Hip fracture ; Hospitals ; Internal medicine ; Medical prognosis ; Mortality ; Pathology ; Patients ; Postoperative complications ; Prevention ; Surgeons ; Surgery ; Surgical delay</subject><ispartof>Journal of clinical anesthesia, 2019-03, Vol.53, p.11-19</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-b1c64519698e5d34762153178f3bcd78ba591d2bd025ba8a379ed98d472310c3</citedby><cites>FETCH-LOGICAL-c396t-b1c64519698e5d34762153178f3bcd78ba591d2bd025ba8a379ed98d472310c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2183146379?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002,64392,64394,64396,72476</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30286380$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reguant, F.</creatorcontrib><creatorcontrib>Arnau, A.</creatorcontrib><creatorcontrib>Lorente, J.V.</creatorcontrib><creatorcontrib>Maestro, L.</creatorcontrib><creatorcontrib>Bosch, J.</creatorcontrib><title>Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.
A non-randomized intervention study with a historical control group (CG).
During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.
240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).
CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.
The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.
512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42–0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44–0.93) were the protective factors for mortality.
The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
•Hip fracture is associated with high morbi-mortality in elderly patients.•A multidisciplinary approach could be reduced postoperative complications and hospital stay.•Surgical delay may not be associated with higher mortality rates.•Main objective of comprehensive care should be to optimize patient's health status.</description><subject>Anemia</subject><subject>Anticoagulants</subject><subject>Clinical pathway</subject><subject>Comorbidity</subject><subject>Consent</subject><subject>Ethics</subject><subject>Fractures</subject><subject>Hemoglobin</subject><subject>Hip fracture</subject><subject>Hospitals</subject><subject>Internal medicine</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Pathology</subject><subject>Patients</subject><subject>Postoperative complications</subject><subject>Prevention</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical delay</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtr3TAQRkVpaW7T_oUg6KYbu3r4Ie1aQvqAQDfZC1kac2V8LVeSE-6_75ibdNFNV2LQmU-aOYTccFZzxrvPUz25OSx2gVowrmqmayb0K3LgqpdV0wr9mhyYbkWluGJX5F3OE2MML_hbciWZUJ1U7ECe7sYxOOvONI7U0tM2l-BDdmHd09OZ2nVN0bojjQtdYy5xhWRLeAR6imlAtiCz-L0qdt4rDILZQ5rPdEUSlpLpUyhHegwrHZN1ZUvwnrwZ7Zzhw_N5TR6-3T3c_qjuf33_efv1vnJSd6UauOualutOK2i9bPpO8FbyXo1ycL5Xg20192LwTLSDVVb2GrxWvumF5MzJa_LpEotD_N4gF3PC4WCecXFxy0Zw3qmWKckR_fgPOsUtLfg5pBBoOgxHqrtQLsWcE4xmTeGEizKcmd2MmcyLGbObMUwbNIONN8_x23AC_7ftRQUCXy4A4DoeAySDFmBx4EMCV4yP4X9v_AE_eqQv</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Reguant, F.</creator><creator>Arnau, A.</creator><creator>Lorente, J.V.</creator><creator>Maestro, L.</creator><creator>Bosch, J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201903</creationdate><title>Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture</title><author>Reguant, F. ; Arnau, A. ; Lorente, J.V. ; Maestro, L. ; Bosch, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-b1c64519698e5d34762153178f3bcd78ba591d2bd025ba8a379ed98d472310c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anemia</topic><topic>Anticoagulants</topic><topic>Clinical pathway</topic><topic>Comorbidity</topic><topic>Consent</topic><topic>Ethics</topic><topic>Fractures</topic><topic>Hemoglobin</topic><topic>Hip fracture</topic><topic>Hospitals</topic><topic>Internal medicine</topic><topic>Medical prognosis</topic><topic>Mortality</topic><topic>Pathology</topic><topic>Patients</topic><topic>Postoperative complications</topic><topic>Prevention</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical delay</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reguant, F.</creatorcontrib><creatorcontrib>Arnau, A.</creatorcontrib><creatorcontrib>Lorente, J.V.</creatorcontrib><creatorcontrib>Maestro, L.</creatorcontrib><creatorcontrib>Bosch, J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reguant, F.</au><au>Arnau, A.</au><au>Lorente, J.V.</au><au>Maestro, L.</au><au>Bosch, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2019-03</date><risdate>2019</risdate><volume>53</volume><spage>11</spage><epage>19</epage><pages>11-19</pages><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.
A non-randomized intervention study with a historical control group (CG).
During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.
240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).
CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.
The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.
512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42–0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44–0.93) were the protective factors for mortality.
The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
•Hip fracture is associated with high morbi-mortality in elderly patients.•A multidisciplinary approach could be reduced postoperative complications and hospital stay.•Surgical delay may not be associated with higher mortality rates.•Main objective of comprehensive care should be to optimize patient's health status.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30286380</pmid><doi>10.1016/j.jclinane.2018.09.029</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0952-8180 |
| ispartof | Journal of clinical anesthesia, 2019-03, Vol.53, p.11-19 |
| issn | 0952-8180 1873-4529 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2116850831 |
| source | Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Anemia Anticoagulants Clinical pathway Comorbidity Consent Ethics Fractures Hemoglobin Hip fracture Hospitals Internal medicine Medical prognosis Mortality Pathology Patients Postoperative complications Prevention Surgeons Surgery Surgical delay |
| title | Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-04T11%3A10%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Efficacy%20of%20a%20multidisciplinary%20approach%20on%20postoperative%20morbidity%20and%20mortality%20of%20elderly%20patients%20with%20hip%20fracture&rft.jtitle=Journal%20of%20clinical%20anesthesia&rft.au=Reguant,%20F.&rft.date=2019-03&rft.volume=53&rft.spage=11&rft.epage=19&rft.pages=11-19&rft.issn=0952-8180&rft.eissn=1873-4529&rft_id=info:doi/10.1016/j.jclinane.2018.09.029&rft_dat=%3Cproquest_cross%3E2116850831%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2183146379&rft_id=info:pmid/30286380&rft_els_id=S0952818018307621&rfr_iscdi=true |