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Optimised programmes help heal hip fractures

A comprehensive treatment and care programme reduces the rate of complications and mortality after hip fracture surgery.

Optimised programmes help heal hip fractures

A comprehensive treatment and care programme reduces the rate of complications and mortality after hip fracture surgery. Researchers from Denmark studied 535 patients with hip fracture aged 40 years and older to evaluate the rate of postoperative complications, length of stay and 1-year mortality before and after the introduction of comprehensive multidisciplinary fast track treatment and care programme for hip fracture patients. The fast track treatment programme comprised several changes including the use of a targeted nerve block instead of opiate painkillers, and earlier assessment by the anesthesiologist. The patients were transferred to a specialised hip fracture ward, which had a more systematic approach to nutrition, oxygen therapy and preventing urinary retention. The hip fractures in elderly person were found associated with the high rates of mortality and disease. In fact, the mortality during the first year after a hip fracture was 15 percent to 35 percent, depending upon the age, sex, etc.; and was comparable to the mortality found in patients with invasive cancer of the large intestine. The researchers on analysing the data after the institution of the programme, found that about 20 percent of the patients included in the programme had at least one in-hospital postoperative complication, compared with 33 percent of those treated before the programme began. The later group also had lower rates of confusion, pneumonia and urinary tract infection and their length of stay was also significantly shorter (10 days versus 16 days). The proportion of patients who could return to their own homes increased from 47 percent to 61 percent after introduction of the optimised programme. Overall 12-month mortality rates were 29 percent in the control group and 23 percent in the optimised treatment group. The results showed that the optimised hip fractures programme reduced the rate of in-hospital postoperative complications and mortality. Further clinical trials are needed to confirm these results and elucidate the elements of the programme that have the greatest effect on outcomes and mortality.
Journal of the American Geriatric Society
October 2008
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