Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center

Jacob R Meyer; Ryan E Earnest; Brian M Johnson; Andrew M Steffensmeier; Dheer A Vyas; Richard T Laughlin

doi:10.1177/21514593231181991

Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center

Geriatr Orthop Surg Rehabil. 2023 Jun 8:14:21514593231181991. doi: 10.1177/21514593231181991. eCollection 2023.

Authors

Jacob R Meyer¹, Ryan E Earnest², Brian M Johnson¹, Andrew M Steffensmeier¹, Dheer A Vyas³, Richard T Laughlin¹

Affiliations

¹ Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Introduction: Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center.

Materials and methods: In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student's t-test and Chi-square testing.

Results: There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 (P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 (P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS (P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 (P = .001).

Discussion: In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2.

Conclusion: A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.

Keywords: COVID-19; geriatric trauma; hip fracture; multidisciplinary; protocol; time to surgery.