title: Effectiveness of a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture: A Multicenter Comparative Cohort Study.
abstract: BACKGROUND
  The use of a multidisciplinary clinical pathway (MCP) for patients with hip fracture tends to be more effective than usual care (UC). The aim of this study was to evaluate the effects of an MCP approach on time to surgery, length of stay, postoperative complications, and 30-day mortality, compared to UC.
  
  
  METHODS
  This multicenter retrospective cohort study included patients aged 50 years or older with a proximal hip fracture who underwent surgery in one of the 6 hospitals in the Limburg trauma region of the Netherlands in 2012. Data such as demographics, process outcome measures, and clinical outcome were collected.
  
  
  RESULTS
  This study included a total of 1193 patients (665 and 528 patients in the MCP and UC groups, respectively). There were no differences in patient demographics present. Time to surgery was significantly shorter in the MCP compared to the UC group (19.2 vs 24.4 hours, P < .01). The mean length of stay was 10 versus 12 days (P < .01). In the MCP group, significantly lower rates of postoperative complications were observed and significantly more patients were institutionalized than in the UC group. Mortality within 30 days after admission was comparable between the groups (overall mortality 6%).
  
  
  CONCLUSIONS
  An MCP approach is associated with reduced time to surgery, postoperative complications, and length of stay, without a significant difference in 30-day mortality. The institutionalization rate was significantly higher in the MCP group.
authors.affiliation: Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: P H S
authors.initials: PH
authors.lastname: Kalmet
authors.affiliation: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard Geleen, the Netherlands.
authors.forename: B B
authors.initials: BB
authors.lastname: Koc
authors.affiliation: Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Hemmes
authors.affiliation: Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: Ten Broeke
authors.affiliation: Department of Orthopaedic Surgery, Laurentius Hospital, Roermond, the Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Dekkers
authors.affiliation: Department of Surgery and Trauma Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Hustinx
authors.affiliation: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard Geleen, the Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Schotanus
authors.affiliation: Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard Geleen, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Tilman
authors.affiliation: Department of Surgery and Trauma Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
authors.forename: H M J
authors.initials: HM
authors.lastname: Janzing
authors.affiliation: Department of Surgery and Trauma Surgery, St Jans Gasthuis, Weert, the Netherlands.
authors.forename: J M A
authors.initials: JM
authors.lastname: Verkeyn
authors.affiliation: Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: P R G
authors.initials: PR
authors.lastname: Brink
authors.affiliation: Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Poeze
keywords: hip fracture; length of stay; mortality; multidisciplinary clinical pathway; time to surgery