Long-term Patient-reported Quality of Life and Pain After a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture: A Retrospective Comparative Cohort Study

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2019 Jun 21

PMID 31218092

Citations 3

Authors

Pishtiwan H S Kalmet

Stijn G C J de Joode

Audrey A A Fiddelers

Rene H M Ten Broeke

Martijn Poeze

Taco Blokhuis

Affiliations

Soon will be listed here.

Abstract

Introduction: There is an increase in incidence of hip fractures in the ageing population. The implementation of multidisciplinary clinical pathways (MCP) has proven to be effective in improving the care for these frail patients, and MCP tends to be more effective than usual care (UC). The aim of this study was to analyze potential differences in patient-reported outcome among elderly patients with hip fractures who followed MCP versus those who followed UC.

Materials And Methods: This retrospective cohort study included patients aged 65 years or older with a low-energy hip fracture, who underwent surgery in the Maastricht University Medical Center, Maastricht, the Netherlands. Two cohorts were analyzed; the first one had patients who underwent UC in 2012 and the second one contained patients who followed MCP in 2015. Collected data regarded demographics, patient-reported outcomes (Short Form 12 [SF-12] and the Numeric Rating Scale [NRS] to measure pain), and patient outcome.

Results: This cohort study included 398 patients, 182 of them were included in the MCP group and 216 were in the UC group. No differences in gender, age, or American Society of Anesthesiologists classification were found between the groups. No significant differences were found in SF-12 and the NRS data between the MCP group and UC group. In the MCP group, significantly lower rates of postoperative complications were found than in the UC group, but mortality within 30 days and one year after the hip fracture was similar in both groups.

Discussion: Although the effects of hip fractures in the elderly on patient-reported outcome, pain and quality of life have been addressed in several recent studies, the effects of MCP on long-term outcome was unclear.

Conclusion: A multidisciplinary clinical pathway approach for elderly patients with a hip fracture is associated with a reduced time to surgery and reduced postoperative complications, while no differences were found in quality of life, pain, or mortality.

Citing Articles

Perception of Goals and Expected Outcomes in Older Hip Fracture Patients and Their Medical Staff: A Cross Sectional Study.

Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmed W, Paltiel O Geriatr Orthop Surg Rehabil. 2023; 14:21514593231202735.

PMID: 37744458 PMC: 10517609. DOI: 10.1177/21514593231202735.

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures: A Systematic Review.

Tewari P, Sweeney Jr B, Lemos J, Shapiro L, Gardner M, Morris A JAMA Netw Open. 2022; 5(9):e2231911.

PMID: 36112373 PMC: 9482052. DOI: 10.1001/jamanetworkopen.2022.31911.

From ER to OR: Results After Implementation of Multidisciplinary Pathway for Fragility Hip Fractures at a Level I Trauma Center.

Anighoro K, Bridges C, Graf A, Nielsen A, Court T, McKeon J Geriatr Orthop Surg Rehabil. 2020; 11:2151459320927383.

PMID: 32547814 PMC: 7249548. DOI: 10.1177/2151459320927383.

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