Clinical application of multidisciplinary team co-management in geriatric hip fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 RUI Yunfeng ^1,2,3,4 , QIU Xiaodong ^3,5 , ZOU Jihong ^3,6 , XIE Tian ^1,2,3,4 , MA Binbin ^1,2,3,4 , LU Panpan ^1,2,3,4 , LI Yingjuan ^3,6 , LIU Songqiao ^3,7 , JIN Jiyang ^3,8 , DENG Chunhua ^1,2,3,4 , CUI Ying ^3,9 , WANG Xiaoyan ^3,10 , MA Ming ^3,11 , REN Liqun ^3,6 , YANG Yi ^3,7 , WANG Chen ^1,2,3,4 , CHEN Hui ^1,2,3,4

1. Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
2. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
3. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
4. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;
5. Department of Anesthesiology, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
6. Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
7. Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
8. Department of Imaging, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
9. Operation Room, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
10. Department of Nursing, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
11. Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding?author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Multidisciplinary team; geriatric hip fracture; clinical application

DOI：

10.7507/1002-1892.201905017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the clinical application of multidisciplinary team (MDT) treatment in the management of geriatric hip fractures and evaluate its effectiveness. Methods The clinical data of 76 elderly patients with hip fracture managed by MDT approach between August 2016 and February 2018 (MDT group) were retrospectively analyzed and compared with 102 patients managed by traditional orthopedics approach between January 2014 and December 2015 (conventional group). There was no significant difference in gender, age, fracture type, surgical procedure, and other general data between the two groups (P>0.05). However, the number of comorbidities in the MDT group was significantly higher than that in the conventional group (t=6.295, P=0.000), and the proportion of the number of comorbidities between the two groups was also significantly different (χ²=28.442, P=0.000). The consultation rate and transfer rate, time to surgery, rate of surgery within 2 or 3 days, operation time, postoperative hospitalization stay, length of hospitalization stay, hospitalization expense, rate of loss to follow-up, and mortality during hospitalization, 30-day mortality, 90-day mortality, and 1-year mortality after operation were compared between the two groups. Results The rates of total consultations of the conventional group and the MDT group were 56.86% (58/102) and 56.58% (43/76), respectively, and the rates of total transferred patients were 15.69% (16/102) and 15.79% (12/76), respectively, with no significant differences (P>0.05). Among them, the proportion of patients who transferred into intensive care unit (ICU) in conventional group was significantly higher than that in MDT group and the rates of patients who received geriatric consultation or transferred into geriatric department in MDT group were both significantly higher than those in conventional group (P<0.05). There was no significant difference in rates of other department consultation or transfer between the two groups (P>0.05). The time to surgery, operation time, postoperative hospitalization stay, and length of hospitalization stay in MDT group were significantly less than those in conventional group, but the proportion of patients who received surgery within 3 days in MDT group was significantly higher than that in conventional group (P<0.05). There was no significant difference in the proportion of patients who received surgery within 2 days (χ²=2.027, P=0.155). The hospitalization expenses of total patients, femoral neck fracture, and intertrochanteric fracture subgroups in MDT group were all significantly higher than those in conventional group (P<0.05). However, there was no significant difference in hospitalization expense of subtrochanteric fracture subgroup between the two groups (Z=?1.715, P=0.086). The rate of loss to follow-up in conventional group and MDT group was 6.86% (7/102) and 3.95% (3/76), respectively, with no significant difference (χ²=0.698, P=0.403). The mortalities at hospitalization, 1 month, 3 months, and 1 year after operation in conventional group were 0, 1.05% (1/95), 3.16% (3/95), and 7.37% (7/95), respectively, and in MDT group were 0, 0, 2.74% (2/73), 6.85% (5/73), respectively, showing no significant differences in mortalities between the two groups (P>0.05). Conclusion MDT model in the management of geriatric hip fractures has been shown to reduce time to surgery, postoperative hospitalization stay, length of hospitalization stay, operation time, and the proportion of patients who received ICU consultation or transferred into ICU. Furthermore, MDT can improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.

Citation： RUI Yunfeng, QIU Xiaodong, ZOU Jihong, XIE Tian, MA Binbin, LU Panpan, LI Yingjuan, LIU Songqiao, JIN Jiyang, DENG Chunhua, CUI Ying, WANG Xiaoyan, MA Ming, REN Liqun, YANG Yi, WANG Chen, CHEN Hui. Clinical application of multidisciplinary team co-management in geriatric hip fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1276-1282. doi: 10.7507/1002-1892.201905017 Copy

1.	Sasabuchi Y, Matsui H, Lefor AK, et al. Timing of surgery for hip fractures in the elderly: A retrospective cohort study. Injury, 2018, 49(10): 1848-1854.
2.	梁玉柱, 郭洪剛. 老年骨質疏松性髖部骨折: 昨天、今天及未來. 中國組織工程研究, 2017, 21(15): 2438-2443.
3.	Ji MH, Yuan HM, Zhang GF, et al. Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery. J Anesth, 2013, 27(2): 236-242.
4.	楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.
5.	吳新寶, 楊明輝, 張萍, 等. 老年病科和骨科共管模式縮短老年髖部骨折患者術前等待時間和住院時間. 骨科臨床與研究雜志, 2017, 2(2): 96-100.
6.	Kehlet H. Enhanced recovery after surgery for hip and knee arthroplasty: where is the evidence? Br J Anaesth, 2017, 118(4): 628.
7.	Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth, 2016, 117(suppl 3): i62-i72.
8.	Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci, 2013, 68(10): 1236-1242.
9.	王國旗, 龍安華, 張立海, 等. 老年髖部骨折合并糖尿病患者圍手術期血糖水平對預后的影響. 中國修復重建外科雜志, 2014, 28(7): 844-847.
10.	Shigemoto K, Sawaguchi T, Goshima K, et al. The effect of a multidisciplinary approach on geriatric hip fractures in Japan. J Orthop Sci, 2019, 24(2): 280-285.
11.	Katrancha ED, Zipf J, Abrahams N, et al. Retrospective evaluation of the impact of a geriatric trauma institute on fragility hip fracture patient outcomes. Orthop Nurs, 2017, 36(5): 330-334.
12.	王金強, 駱洪濤, 彭城, 等. 極高齡髖部骨折患者術后一年病死的危險因素分析. 中國骨與關節雜志, 2019, 8(3): 187-190.
13.	中國老年醫學學會骨與關節分會創傷骨科學術工作委員會. 老年髖部骨折診療專家共識 (2017). 中華創傷骨科雜志, 2017, 19(11): 921-927.
14.	Shenouda M, Silk Z, Radha S, et al. The introduction of a multidisciplinary hip fracture pathway to optimise patient care and reduce mortality: a prospective audit of 161 patients. Open Orthop J, 2017, 11: 309-315.
15.	Lau TW, Fang C, Leung F. The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower. Osteoporos Int, 2017, 28(3): 791-798.
16.	楊明輝, 王顥, 李文菁, 等. 骨科和老年科共同管理模式治療老年人髖部骨折的療效分析. 中華老年醫學雜志, 2018, 37(12): 1312-1315.
17.	張會會, 韓玲, 劉琴, 等. 多學科協作診療模式在深化醫院學科建設的探討. 中國醫院管理, 2018, 38(10): 29-30.
18.	Morri M, Forni C, Marchioni M, et al. Which factors are independent predictors of early recovery of mobility in the older adults’ population after hip fracture? A cohort prognostic study Arch Orthop Trauma Surg, 2018, 138(1): 35-41.
19.	Forni S, Pieralli F, Sergi A, et al. Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Arch Gerontol Geriatr, 2016, 66: 13-17.
20.	于榮華, 梁朝革, 唐獻忠, 等. 老年髖部骨折手術時機及住院時間的相關因素研究. 中國矯形外科雜志, 2013, 21(24): 2481-2485.
21.	Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One, 2012, 7(10): e46175.
22.	謝添, 馬彬彬, 李滎娟, 等. 加速康復外科在老年髖部骨折的研究現狀. 中國修復重建外科雜志, 2018, 32(8): 1038-1046.
23.	丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.

1. Sasabuchi Y, Matsui H, Lefor AK, et al. Timing of surgery for hip fractures in the elderly: A retrospective cohort study. Injury, 2018, 49(10): 1848-1854.
2. 梁玉柱, 郭洪剛. 老年骨質疏松性髖部骨折: 昨天、今天及未來. 中國組織工程研究, 2017, 21(15): 2438-2443.
3. Ji MH, Yuan HM, Zhang GF, et al. Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery. J Anesth, 2013, 27(2): 236-242.
4. 楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.
5. 吳新寶, 楊明輝, 張萍, 等. 老年病科和骨科共管模式縮短老年髖部骨折患者術前等待時間和住院時間. 骨科臨床與研究雜志, 2017, 2(2): 96-100.
6. Kehlet H. Enhanced recovery after surgery for hip and knee arthroplasty: where is the evidence? Br J Anaesth, 2017, 118(4): 628.
7. Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth, 2016, 117(suppl 3): i62-i72.
8. Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci, 2013, 68(10): 1236-1242.
9. 王國旗, 龍安華, 張立海, 等. 老年髖部骨折合并糖尿病患者圍手術期血糖水平對預后的影響. 中國修復重建外科雜志, 2014, 28(7): 844-847.
10. Shigemoto K, Sawaguchi T, Goshima K, et al. The effect of a multidisciplinary approach on geriatric hip fractures in Japan. J Orthop Sci, 2019, 24(2): 280-285.
11. Katrancha ED, Zipf J, Abrahams N, et al. Retrospective evaluation of the impact of a geriatric trauma institute on fragility hip fracture patient outcomes. Orthop Nurs, 2017, 36(5): 330-334.
12. 王金強, 駱洪濤, 彭城, 等. 極高齡髖部骨折患者術后一年病死的危險因素分析. 中國骨與關節雜志, 2019, 8(3): 187-190.
13. 中國老年醫學學會骨與關節分會創傷骨科學術工作委員會. 老年髖部骨折診療專家共識 (2017). 中華創傷骨科雜志, 2017, 19(11): 921-927.
14. Shenouda M, Silk Z, Radha S, et al. The introduction of a multidisciplinary hip fracture pathway to optimise patient care and reduce mortality: a prospective audit of 161 patients. Open Orthop J, 2017, 11: 309-315.
15. Lau TW, Fang C, Leung F. The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower. Osteoporos Int, 2017, 28(3): 791-798.
16. 楊明輝, 王顥, 李文菁, 等. 骨科和老年科共同管理模式治療老年人髖部骨折的療效分析. 中華老年醫學雜志, 2018, 37(12): 1312-1315.
17. 張會會, 韓玲, 劉琴, 等. 多學科協作診療模式在深化醫院學科建設的探討. 中國醫院管理, 2018, 38(10): 29-30.
18. Morri M, Forni C, Marchioni M, et al. Which factors are independent predictors of early recovery of mobility in the older adults’ population after hip fracture? A cohort prognostic study Arch Orthop Trauma Surg, 2018, 138(1): 35-41.
19. Forni S, Pieralli F, Sergi A, et al. Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Arch Gerontol Geriatr, 2016, 66: 13-17.
20. 于榮華, 梁朝革, 唐獻忠, 等. 老年髖部骨折手術時機及住院時間的相關因素研究. 中國矯形外科雜志, 2013, 21(24): 2481-2485.
21. Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One, 2012, 7(10): e46175.
22. 謝添, 馬彬彬, 李滎娟, 等. 加速康復外科在老年髖部骨折的研究現狀. 中國修復重建外科雜志, 2018, 32(8): 1038-1046.
23. 丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of multidisciplinary team co-management in geriatric hip fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content