[Accelerated recovery program after hip fracture surgery].
BACKGROUND
A multimodal approach to minimise the effect of the surgical stress response can reduce complications and hospital stay after abdominal surgery and hip arthroplasty. The aim of the study was to assess the results of a well-defined rehabilitation programme after hip fracture.


METHODS
In an open intervention study, we entered 200 consecutive patients with hip fracture allowing full weight-bearing after operative treatment. The effect of a revised, optimised perioperative care programme with continuous epidural analgesia, early oral nutrition, oxygen supplementation, restricted volume and transfusion therapy, and intensive physiotherapy and mobilisation was assessed (n = 100) and compared with the conventional perioperative treatment programme before the intervention (n = 100). The median age was 82 (56-96) years in the control group and 82 (63-101) years in the accelerated multimodal perioperative treatment group.


RESULTS
The median hospital stay was reduced from 21 (range 1-162, mean 32) to 11 (range 1-100, mean 17) days. The total use of days in hospital was reduced from 3211 to 1667. There were fewer complications, whereas the need for home care after discharge was unchanged.


CONCLUSIONS
An accelerated clinical pathway with focus on pain relief, oral nutrition, and rehabilitation may reduce hospital stay and improve recovery after hip fracture.
Rasmussen
Sten
S
Ortopaedkirurgisk afdeling, Vejle Sygehus, DK-7300 Vejle. sten.rasmussen@dadlnet.dk
Kristensen
Billy B
BB
Foldager
Susanne
S
Myhrmann
Lis
L
Kehlet
Henrik
H
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000534:rehabilitation*; D003718:Denmark; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies