title: Perioperative multimodal optimisation in patients undergoing surgery for fractured neck of femur.
abstract: BACKGROUND
  Enhanced Recovery after Surgery protocols are associated with reduced length of stay and morbidity in patients undergoing major surgery. The aim of this audit was to assess the impact of a multimodal optimisation protocol in patients admitted with fractured neck of femur.
  
  
  METHODS
  A multimodal optimisation protocol was introduced for the care of patients with proximal femoral fractures. The short-term effects of the optimised perioperative care programme was assessed and compared with the conventional perioperative care before the intervention.
  
  
  RESULTS
  A total of 232 patients were included in this audit, 117 optimised care and 115 conventional care. Patients were similar with regards to age, gender, domicile, mental status and the type of operation. The optimised group suffered from fewer post-operative complications (36 out of 117 vs 48 out of 115, P = 0.04, Chi square test). There was no significant difference between two groups with regards to the length of hospital stay and 30-day mortality.
  
  
  CONCLUSIONS
  Multimodal optimisation may be associated with a decline in post-operative morbidity in patients with proximal hip fracture. It does not have any significant impact on the length of hospital stay and 30-day mortality.
authors.affiliation: Scarborough General Hospital, Scarborough, Yorkshire, UK.
authors.forename: David
authors.initials: D
authors.lastname: Macfie
authors.forename: Reza Arsalani
authors.initials: RA
authors.lastname: Zadeh
authors.forename: Mark
authors.initials: M
authors.lastname: Andrews
authors.forename: Jonathan
authors.initials: J
authors.lastname: Crowson
authors.forename: John
authors.initials: J
authors.lastname: Macfie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D005592:Fracture Fixation / Q000401:mortality / Q000534:rehabilitation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D016896:Treatment Outcome