title: Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients.
abstract: Since most hip fractures occur in fragile patients, an important step forward in the treatment may be a co-managed, multidisciplinary treatment approach with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with the usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon. The primary aim of this study was to assess the effect of the MCM on 30-day mortality, compared with the UCM.
  
  
  
  A retrospective study was conducted on patients with main diagnosis of hip fracture, as reported in the hospital admission discharge reports, aged 65 years and older, who underwent surgery in Tuscan hospitals from 2010 to 2013. A multilevel logistic regression model was performed to assess the effect of the MCM vs the UCM. The Charlson Comorbidity Index (CCI) was used as a proxy for case mix complexity.
  
  
  
  23,973 patients were included: 23% men and 77% women; the mean age was 83.5 years. The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR=1.32; 95% CI 1.09-1.59; p=0.004). Surgical delay was not significantly associated with higher mortality rates.
  
  
  
  A co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to a reduction in mortality after hip fracture surgery.
authors.affiliation: Tuscan Regional Health Agency, Via Pietro Dazzi, 1, 50141 Florence, Italy. Electronic address: silvia.forni@ars.toscana.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Forni
authors.affiliation: School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale Giovan Battista Morgagni, 48, 50134 Florence, Italy. Electronic address: f.pieralli@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pieralli
authors.affiliation: Tuscan Regional Health Agency, Via Pietro Dazzi, 1, 50141 Florence, Italy. Electronic address: alessandro.sergi@ars.toscana.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sergi
authors.affiliation: Department of Health Sciences, University of Florence, Viale Giovan Battista Morgagni, 48, 50134 Florence, Italy. Electronic address: chiara.lorini@unifi.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lorini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Viale Giovan Battista Morgagni, 48-50134 Florence, Italy. Electronic address: guglielmo.bonaccorsi@unifi.it.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Bonaccorsi
authors.affiliation: Tuscan Regional Health Agency, Via Pietro Dazzi, 1, 50141 Florence, Italy. Electronic address: andrea.vannucci@ars.toscana.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D009026:Mortality; D055361:Multilevel Analysis; D010348:Patient Care Team; D010351:Patient Discharge; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
keywords: Elderly; Hip fracture; Hospital care; Orthogeriatric management; Patient outcomes; Time to surgery