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. 2022 May;34(5):1149-1158.
doi: 10.1007/s40520-021-02038-z. Epub 2022 Jan 24.

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

Mingming Fu #  1 , Yaqian Zhang #  1 , Junfei Guo  2 , Yuqi Zhao  1 , Zhiyong Hou  2   3 , Zhiqian Wang  4 , Yingze Zhang  5   6   7
Affiliations

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

Mingming Fu et al. Aging Clin Exp Res. 2022 May.

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.

Keywords: Complications; Geriatric; Hip fracture; Management bundle; Perioperative heart failure; Survival.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
The flow diagram of this study
Fig. 2
Fig. 2
Scatterplot of the correlations between B-type natriuretic peptide and C-reactive protein levels
Fig. 3
Fig. 3
Kaplan–Meier survival curves for elderly patients with perioperative heart failure
See this image and copyright information in PMC

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