Efficacy of an interdisciplinary pathway in a first level trauma center orthopaedic unit: A prospective study of a cohort of elderly patients with hip fractures

Abstract

Background: hip fracture has negative consequences for elderly people. Alternative models of care, with respect to traditional model, were developed to minimize complications and improve functional outcomes. The interdisciplinary model in orthopaedic wards has less evidence of efficacy compared to orthogeriatric units.

Objective: to compare the efficacy (in-hospital outcomes, mortality, functional status at 6 months after discharge) of an interdisciplinary pathway, based on comprehensive geriatric assessment, compared to a traditional model of care, in hip-fractured elderly patients.

Design: prospective study with retrospective control group conducted in a first-level trauma center Orthopaedic Unit.

Subjects: 97 patients treated with the traditional model and 127 with an interdisciplinary pathway (mean age 83.9 ± 7.4 vs 84 ± 6.7 years, p = 0.89).

Methods: in all participants we assessed: clinical history, functional pre-fracture status utilising Activities of Daily Living (ADL), in-hospital details. At 6 months after discharge, we evaluated functional status, place of residence, hospital readmissions, mortality.

Results: during hospital stay, significant differences emerged in mortality and in external visits. A higher proportion of patients of the orthogeriatric group lived alone at home at 6 months and showed a lower functional decline. Comprehensive geriatric assessment was associated with the ADL score (partial R²: 0.08, p < 0.001) and with a higher probability of independent walking ability ([OR] 3.89 95% [CI] 1.73-8.74, p = 0.001).

Conclusions: an interdisciplinary pathway in hip-fractured elderly patients, could reduce in-hospital mortality, improve functional recovery and increase the probability of living alone at home, at 6 months.

Keywords: Functional recovery; Hip fracture; Mortality; Older adults; Orthogeriatrics.