Application of Integrated Management Bundle Incorporating with Multidisciplinary Measures Improved In-hospital Outcomes and Early Survival in Geriatric Hip Fracture Patients with Perioperative Heart Failure: a Retrospective Cohort Study

Overview

Journal Aging Clin Exp Res

Publisher Springer

Specialty Geriatrics

Date 2022 Jan 24

PMID 35067910

Authors

Mingming Fu

Yaqian Zhang

Junfei Guo

Yuqi Zhao

Zhiyong Hou

Zhiqian Wang

Yingze Zhang

Affiliations

Soon will be listed here.

Abstract

Background: In elderly, hip fracture is often complicated by perioperative heart failure, related to worse prognosis. We aimed to analyze the effects of integrated management bundle incorporating with multidisciplinary measures on in-hospital outcomes and early survival in elderly hip fracture patients with perioperative heart failure.

Methods: In this retrospective cohort study, a total of 421 hip fracture patients aged 65 and over who developed perioperative heart failure were included. According to different perioperative management modes applied, patients were retrospectively divided into multidisciplinary management group (Group A), including 277 patients, and integrated management bundle group (Group B), including 144 patients. The B-type natriuretic peptide (BNP) and C-reactive protein (CRP) levels, complications, length of stay, and hospitalization costs were observed and compared between two groups. Overall survival was compared by Kaplan-Meier methods. Cox regression analysis was used to identify prognostic factors associated with overall survival.

Results: A total of 421 patients were enrolled for analysis, including 277 in Group A and 144 in Group B. BNP and CRP levels were significantly decreased compared with admission (P < 0.05). Furthermore, BNP and CRP in Group B decreased much more than those in Group A (P < 0.05). The reductions were observed in length of stay, hospitalization costs and incidence of pulmonary infection, hypoproteinemia, and acute cerebral infarction in Group B (all P < 0.05). The Kaplan-Meier plots showed significantly superior overall survival in Group B. Integrated management bundle was independent favorable prognostic factors.

Conclusions: The integrated management bundle incorporating with multidisciplinary measures significantly improved the therapeutic effect of perioperative heart failure, reduced inflammatory response, and yielded better hospital outcomes. It brought better survival benefits for geriatric hip fracture patients with perioperative heart failure. The results of this study can play an important role in clinical work and provide a valuable theoretical basis for selection of management model in elderly hip fracture patients with perioperative heart failure.

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