Abstract
Introduction
While interdisciplinary protocols and expedited surgical treatment improve management of geriatric hip fractures, the impact of such interventions on patients undergoing specifically arthroplasty for femoral neck fracture (FNF) has not been well studied. The aim of this study is to evaluate the efficacy of an interdisciplinary hip fracture protocol for patients undergoing arthroplasty for acute FNF.
Methods
In 2017, our tertiary care institution implemented a standardized interdisciplinary hip fracture protocol. We conducted a retrospective review of adult patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for FNF from July 2012 – March 2020, and compared patient characteristics, hospitalization characteristics, and outcomes between those treated before and after protocol implementation.
Results
157 patients were treated before implementation (22.3% THA), and 114 patients were treated after implementation (32.5% THA). Demographics and medical comorbidities were similar before and after protocol implementation. Patients who underwent HA were older (82.1 vs 71.1 years, p<0.001), more medically complex (Charlson Comorbidity Index 6.4 vs 4.1, p<0.001), and more likely to develop delirium (8.5% vs 0%, p=0.024) than those who underwent THA. Patients treated after implementation had reduced time between admission and operative management (24.1 vs 46.5 hours, p=0.042), decreased rate of major complications (0% vs 12.7%, p<0.001), decreased hospital length of stay (LOS) (5.2 vs 6.4 days, p=0.008), increased rate of discharge to home (26.3% vs 14.7%, p=0.03), and decreased 365-day mortality (14.6% vs 26.1%, p=0.049). There were no significant differences between post-protocol and pre-protocol, respectively, 90-day readmission (18.2% vs 21.7%, p=0.53) or 30-day mortality (3.7% vs 5.1%, p=1.0).
Conclusion
This interdisciplinary protocol reduced time to operative management, hospital LOS, in-hospital complications, and one-year mortality for patients who underwent arthroplasty for FNF, without increasing readmission or non-home discharge. Such interventions are critical in improving outcomes and reducing costs for an aging population.
