Introduction

The purpose of this study was to assess the hospital quality measures and outcomes of operative hip fracture patients before and after implementation of an anesthesiology department protocol assigning decision for a preoperative transthoracic echocardiogram (TTE) to the hospitalist co-managing physician.

Materials and Methods

Demographics, injury details, hospital quality measures, and outcomes were reviewed for a consecutive series of patients presenting to our institution with an operative hip fracture. In May of 2019, a new protocol assigning the responsibility to indicate a patient for preoperative TTE was mandated to the co-managing hospitalist at the institution. Patients were split into pre-protocol and post-protocol cohorts. Linear regression modeling and comparative analyses were conducted with a Bonferroni adjusted alpha as appropriate.

Results

Between September 2015 and June 2021, 1002 patients presented to our institution and were diagnosed with a hip fracture. Patients in the post-protocol cohort were less likely to undergo a preoperative echocardiogram, experienced a shorter time (days) to surgery, shorter length of stay, an increase in amount of home discharges, and lower complication risks for urinary tract infection and acute blood loss anemia as compared to those in the pre-protocol cohort. There were no differences seen in inpatient or 30-day mortality. Multivariable linear regression demonstrated a patient’s comorbidity profile (Charlson Comorbidity Index (CCI)) and their date of presentation (pre- or post-protocol), were both associated with (P<0.01) a patients' time to surgery.

Conclusion

A standardized preoperative work flow protocol regarding which physician evaluates and determines which patients require a preoperative TTE allows for a streamlined perioperative course for hip fracture patients. This allows for a shortened time to surgery and length of stay with an increase in home discharges and was associated with a reduced risk of common index hospitalization complications including UTI and anemia.

中文翻译：

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确定术前超声心动图使用的标准化术前途径继续改善髋部骨折质量

介绍

本研究的目的是评估在实施麻醉科协议将术前经胸超声心动图 (TTE) 决策分配给住院医师共同管理医师之前和之后，髋部骨折手术患者的医院质量措施和结果。

材料和方法

对就诊于我们机构的髋部手术骨折患者的连续系列患者的人口统计资料、损伤细节、医院质量测量和结果进行了审查。2019 年 5 月，一项新的协议授权该机构的共同管理住院医师负责指示患者进行术前 TTE。患者被分为方案前和方案后队列。使用适当的 Bonferroni 调整的 alpha 进行线性回归建模和比较分析。

结果

2015 年 9 月至 2021 年 6 月期间，1002 名患者到我们机构就诊并被诊断为髋部骨折。方案后队列中的患者不太可能接受术前超声心动图检查，手术时间（天）更短，住院时间更短，出院次数增加，尿路感染和急性血液并发症风险更低与方案前队列相比，丢失性贫血。住院或 30 天死亡率没有差异。多变量线性回归表明患者的合并症特征（Charlson 合并症指数 (CCI)）及其就诊日期（方案前或方案后）均与 (P<0.01) 患者的手术时间相关。

结论

关于哪些医生评估和确定哪些患者需要术前 TTE 的标准化术前工作流程协议允许为髋部骨折患者简化围手术期过程。这可以缩短手术时间和住院时间，增加家庭出院次数，并降低常见指数住院并发症（包括尿路感染和贫血）的风险。