[Comparison between the short program and the long program of post-operative rehabilitation of hip fracture for making the critical path]

Abstract

Patients receiving operative treatment for fracture are good candidate for critical path management. Recently, we have developed a Short Program (SP) for post-operative rehabilitation of hip fractures. The purpose of this study was to evaluate the effectiveness, the safety and the cost efficiency of this SP, by comparing it with the former Long Program (LP) in terms of choosing the better program for the critical path. The enrolled patients were over 65 years old, had been able to walk by themselves with or without canes, were free from neurological diseases like hemiplegia and Parkinson's disease, and without pathological fractures. We enrolled 101 patients (mean age: 83.1) for the LP and 143 patients (mean age: 82.8) for the SP. The operative procedure for these patients was internal fixation with a sliding hip screw or prosthetic replacement for a femoral head. Length of hospitalization, the rate of recovering walking ability, medical expenses during hospitalization, and the types and incidence of complications were investigated to determine differences between the SP and the LP. Length of hospitalization was significantly shorter in SP patients (p < 0.01). The ratio of recovering walking ability was equal in both programs, while that among the patients with dementia was lower in the SP group. Medical expenses were significantly less in SP (p < 0.01). The SP had fever complications than the LP group (p < 0.05). As a result, the SP was superior to the LP in terms of effectiveness, safety and cost efficiency, thus it was considered to be suitable for critical path management of hip fracture cases. However, because recovery of walking ability was harder for patients over 85 years old with the SP than with the LP, a modified program is necessary for such older patients.