Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study.
BACKGROUND
Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons.


METHODS
During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing on all facets of peri-operative care. Two hours were allotted to rounds in the 14-bed unit. One hundred and twenty-six consecutive patients admitted to the unit in 2003, receiving the same well-defined care programme, were chosen as a control group. Outcome measures were morbidity and the need for visits by external specialists.


RESULTS
The intervention group received 291 rounds by anaesthesiologists. Active therapeutic interventions were prescribed in 76% of all patient confrontations. The control group received 128 requested visits from internal medicine specialists, which was reduced to 50 in the intervention group (P = 0.02). There was no significant difference between post-operative morbidity and hospital stay in the control and intervention groups; in-hospital mortality was 12% in the control group and 7% in the intervention group (P = 0.24). The rounds by anaesthesiologists improved nursing care conditions.


CONCLUSIONS
This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome aspects, providing anaesthesiological rounds 7 days per week.
Department of Anaesthesia, Hvidovre University Hospital, Copenhagen, Denmark. nicolai.bang.foss@hh.hosp.dk
N B
NB
Foss
D S
DS
Christensen
M
M
Krasheninnikoff
B B
BB
Kristensen
H
H
Kehlet
D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay; D008875:Middle Aged; D009985:Orthopedics; D010865:Pilot Projects; D011182:Postoperative Care; D011183:Postoperative Complications