Emergency Department Orthogeriatric Care and Length of Stay in Hip Fracture Patients: A Retrospective Cohort Study

Abstract

Hip fractures are linked to significant morbidity and death and are a common reason for older persons to visit the emergency department (ED). Orthogeriatric interdisciplinary care models maximize perioperative management and enhance care for these vulnerable patients by enabling early clinical assessment, quick diagnostics, and customized analgesia by regional anesthesia (RA). There is still a lack of research on the precise effects of these models on ED length of stay (LOS). This study evaluated the impact of an orthogeriatric fast-track based on a multidisciplinary treatment approach on ED LOS. Secondary goals included assessing how this implementation affected the rate of complications, early death, and analgesia effectiveness in ED. Method: Patients with hip fractures who were 65 years of age or older were included in this monocentric observational retrospective cohort, which was conducted in a Swiss emergency department both before and after fast-track deployment. Polytrauma, incapacity to give consent, and RA contraindication or patient rejection were the exclusion criteria. ED LOS was the main result. Secondary outcomes were 30-day mortality, 72-hour complications rate, and analgesic efficiency in the ED (i.e., NRS reduction, cumulative opioid intake). For quantitative variables, the Wilcoxon rank sum test was employed,  and for qualitative variables, Fisher's test. In conclusion:An orthogeriatric fast-track approach is linked to a decreased early death rate and a considerable reduction in ED LOS. There is no opioid sparing effect, although analgesia efficiency is positively influenced.