Five-year Clinical Outcome of the Clincal Pathway for Geriatric Hip Fracture_West China Medical Journal

Authors：

 JIANGJun-wei , LIUKai , WANGHong-chuan , WANGYong-cai , YANBin

Department of Orthopaedics, People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

Keywords：

Geriatric hip fracture; Clinical pathway; Therapeutic outcome; Elderly

DOI：

10.7507/1002-0179.20140324

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Objective To introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. Methods The geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. Results After the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. Conclusion The use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.

Citation： JIANGJun-wei, LIUKai, WANGHong-chuan, WANGYong-cai, YANBin. Five-year Clinical Outcome of the Clincal Pathway for Geriatric Hip Fracture. West China Medical Journal, 2014, 29(6): 1056-1059. doi: 10.7507/1002-0179.20140324 Copy

1.	Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study[J]. BMJ, 2005, 331(7529): 1374.
2.	Friedman SM, Mendelson DA, Kates SL, et al. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population[J]. J Am Geriatr Soc, 2008, 56(7): 1349-1356.
3.	Pandey R, Mcnally E, Ali A, et al. The role of MRI in the diagnosis of occult hip fractures[J]. Injury, 1998, 29(1): 61-63.
4.	Ricci WM, Della Rocca GJ, Combs C, et al. The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures[J]. Injury, 2007, 38(Suppl 3): S49-S52.
5.	Parker MJ, Handoll HH. Pre-operative traction for fractures of the proximal femur in adults[J]. Cochrane Database Syst Rev, 2006, 19(3): CD000168.
6.	Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis[J]. Clin Orthop Relat Res, 2004(419): 179-184.
7.	Levi N. Urinary tract infection and cervical hip fracture[J]. Int J Risk Safety Med, 1998, 11(1): 41-44.
8.	Handoll HH, Farrar MJ, Mcbirnie J, et al. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures[J]. Cochrane Database Syst Rev, 2000, 4(2): CD000305.
9.	Mclaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture[J]. J Gen Intern Med, 2006, 21(3): 219-225.
10.	Parker MJ, Handoll H, Griffiths R. Anaesthesia for hip fracture surgery in adults[J]. Cochrane Libr, 2006(4): CD000521.
11.	Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?[J]. Osteoporos Int, 2010, 21(Suppl 4): S555-S572.
12.	Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management[J]. Anesth Analg, 1997, 85(4): 874-885.
13.	Hogue CW, Goodnough LT, Monk TG. Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy[J]. Transfusion (Paris), 1998, 38(10): 924-931.
14.	Hamlet WP, Lieberman JR, Freedman EL, et al. Influence of health status and the timing of surgery on mortality in hip fracture patients[J]. Am J Orthop (Belle Mead NJ), 1997, 26(9): 621-627.
15.	Wetherell RG, Hinves BL. The Hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck. A 10-year prospective study[J]. J Bone Joint Surg Br, 1990, 72(5): 788-793.
16.	Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip[J]. Ann R Coll Surg Engl, 1994, 76(5): 327-329.
17.	Audigé L, Hanson B, Swiontkowski MF. Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices[J]. Int Orthop, 2003, 27(4): 197-203.
18.	夏軍, 魏亦兵, 黃鋼勇, 等. 手術治療高齡髖部骨折的圍手術期并發癥[J]. 中華骨科雜志, 2005, 25(10): 591-594.

1. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study[J]. BMJ, 2005, 331(7529): 1374.
2. Friedman SM, Mendelson DA, Kates SL, et al. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population[J]. J Am Geriatr Soc, 2008, 56(7): 1349-1356.
3. Pandey R, Mcnally E, Ali A, et al. The role of MRI in the diagnosis of occult hip fractures[J]. Injury, 1998, 29(1): 61-63.
4. Ricci WM, Della Rocca GJ, Combs C, et al. The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures[J]. Injury, 2007, 38(Suppl 3): S49-S52.
5. Parker MJ, Handoll HH. Pre-operative traction for fractures of the proximal femur in adults[J]. Cochrane Database Syst Rev, 2006, 19(3): CD000168.
6. Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis[J]. Clin Orthop Relat Res, 2004(419): 179-184.
7. Levi N. Urinary tract infection and cervical hip fracture[J]. Int J Risk Safety Med, 1998, 11(1): 41-44.
8. Handoll HH, Farrar MJ, Mcbirnie J, et al. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures[J]. Cochrane Database Syst Rev, 2000, 4(2): CD000305.
9. Mclaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture[J]. J Gen Intern Med, 2006, 21(3): 219-225.
10. Parker MJ, Handoll H, Griffiths R. Anaesthesia for hip fracture surgery in adults[J]. Cochrane Libr, 2006(4): CD000521.
11. Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?[J]. Osteoporos Int, 2010, 21(Suppl 4): S555-S572.
12. Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management[J]. Anesth Analg, 1997, 85(4): 874-885.
13. Hogue CW, Goodnough LT, Monk TG. Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy[J]. Transfusion (Paris), 1998, 38(10): 924-931.
14. Hamlet WP, Lieberman JR, Freedman EL, et al. Influence of health status and the timing of surgery on mortality in hip fracture patients[J]. Am J Orthop (Belle Mead NJ), 1997, 26(9): 621-627.
15. Wetherell RG, Hinves BL. The Hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck. A 10-year prospective study[J]. J Bone Joint Surg Br, 1990, 72(5): 788-793.
16. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip[J]. Ann R Coll Surg Engl, 1994, 76(5): 327-329.
17. Audigé L, Hanson B, Swiontkowski MF. Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices[J]. Int Orthop, 2003, 27(4): 197-203.
18. 夏軍, 魏亦兵, 黃鋼勇, 等. 手術治療高齡髖部骨折的圍手術期并發癥[J]. 中華骨科雜志, 2005, 25(10): 591-594.

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Five-year Clinical Outcome of the Clincal Pathway for Geriatric Hip Fracture

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