Objective: 

To determine the financial and clinical impact of a standardized, multidisciplinary team for surgical clearance and optimization in geriatric hip fracture patients.

Design: 

Retrospective case series.

Setting: 

Level-1 trauma center.

Patients: 

One hundred twenty-four geriatric patients (age >65 years old) in the preprotocol group (cohort 1; January 2017–December 2018) and 98 geriatric patients in the postprotocol group (cohort 2; October 2019–January 2021) with operative hip fractures.

Intervention: 

Implementation of a multidisciplinary team protocol consisting of Anesthesiology, Internal Medicine and Orthopedic Surgery departments for the assessment of medical readiness and optimization for surgical intervention in geriatric hip fractures.

Main Outcome Measures: 

Rate of cardiology consultation, need for cardiac workup (echocardiography stress testing, heath catheterization), time to medical readiness (TTMR), time to surgery, case-cancellation rate, length of stay (LOS), and total hospitalization charges.

Results: 

Following implementation of the new protocol, there were significant (P < 0.001) decreases in TTMR (19 vs. 11 hours), LOS (149 vs. 120 hours), case cancellation rate, and total hospital charges ($84,000 vs. $62,000). There were no significant differences with respect to in-hospital complications or readmission rates/mortality rates at 1 year.

Conclusions: 

Following implementation of a protocolized, multidisciplinary approach to optimizing geriatric fracture patients, we were able to demonstrate a reduction in unnecessary preoperative testing, TTMR for surgery, case cancellation rate, LOS, and total hospitalization charge—without a concomitant increase in complications or mortality. This study highlights that standardization of the perioperative care for geriatric hip fracture patients can provide effective patient care while also lowering financial and logistical burden in care for these injuries.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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一种新的老年髋部骨折多学科术前检查策略的评价

客观的： 

确定标准化、多学科团队对老年髋部骨折患者的手术清除和优化的财务和临床影响。

设计： 

回顾性案例系列。

环境： 

一级创伤中心。

患者： 

方案前组（队列 1；2017 年 1 月至 2018 年 12 月）中的 124 名老年患者（年龄>65 岁）和方案后组（队列 2；2019 年 10 月至 2021 年 1 月）中的 98 名老年患者（队列 2；2019 年 10 月至 2021 年 1 月） .

干涉： 

实施由麻醉科、内科和骨外科组成的多学科团队协议，用于评估老年髋部骨折手术干预的医疗准备情况和优化。

主要观察指标： 

心脏病咨询率、心脏检查需求（超声心动图压力测试、健康导管插入术）、医疗准备时间 (TTMR)、手术时间、病例取消率、住院时间 (LOS) 和住院总费用。

结果： 

新方案实施后，TTMR（19 与 11 小时）、LOS（149 与 120 小时）、病例取消率和总医院费用（84,000 美元与 62,000 美元）显着降低（P < 0.001）。1 年时的住院并发症或再入院率/死亡率没有显着差异。

结论： 

在实施了优化老年骨折患者的协议化、多学科方法后，我们能够证明不必要的术前检查、手术 TTMR、病例取消率、LOS 和总住院费用减少，而并发症或死亡率没有随之增加。本研究强调，老年髋部骨折患者围手术期护理的标准化可以提供有效的患者护理，同时降低这些损伤护理的财务和后勤负担。

证据等级： 

治疗级别 III。有关证据级别的完整描述，请参见作者说明。