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Abstract
Background and Aims Hip fracture (HF) exacerbates loss of autonomy in the elderly.Several studies focus on improving outcome by intervening on one single aspect of perioperative management.1We aimed to observewhether a multidisciplinary management algorithm rather than a single change to a single aspect of perioperative management had an impact on early 7-days postoperative complications (EPOCs).The implemented algorithm(“ASAP”=Advice, Surgery, Analgesia, and Pharmacology)includedorthogeriatrician care, delay to surgery <12 hours (DOS), supra-inguinal fascia iliaca block (SFIB), and therapy’s adaptation,i.e. avoiding perioperative anti-cholinergic drugs.
Methods Patients were divided in 2 cohorts according to date of admission. Pre-ASAP cohort included HF from January 1st, 2019, to December 31th, 2019; post-ASAP cohort included HF from January 1st, 2020 (date of ASAP implementation), to December 31th, 2020. After approval by our ethics board, a prospective before-after analysis of retrospective data was conducted assuming EPOCs as primary outcome. EPOCs were stratified according to Clavien-Dindo classification into minor (grade 1) and major (grades 2/3/4).2
Results 249 consecutive patients admitted with HF were included in this before-after analysis. Interrupted time-series (ITS) and Kaplane-Meier analysisfrom 134 (pre-ASAP) and 115 (post-ASAP) patients demonstrate thatASAP algorithm reduces all EPOCs (Figure 1–2).
Cox proportional-hazards models on qualitative and quantitative single-item analysis demonstrates that SFIB significantly reduces EPOCs and that therapeutic adaptation in patient‘s treatment increases EPOCs (Figure 3).
Conclusions SFIB is the most effective aspect associated with EPOCs reduction in HF following the implementation of our multidisciplinary ASAP algorithm.