title: In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team.
abstract: OBJECTIVE
  Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist.
  
  
  METHODS
  In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality.
  
  
  RESULTS
  In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132).
  
  
  CONCLUSIONS
  Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.
authors.affiliation: Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy.|SOD Medicina Interna e post-chirurgica, AOU Careggi, Firenze, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rostagno
authors.affiliation: SOD Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Buzzi
authors.affiliation: SOD Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Campanacci
authors.affiliation: SOD Anestesia, AOU Careggi, Firenze, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Boccacini
authors.affiliation: SOD Medicina Interna e post-chirurgica, AOU Careggi, Firenze, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cartei
authors.affiliation: Direzione Sanitaria, AOU Careggi, Firenze, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Virgili
authors.affiliation: Direzione Sanitaria, AOU Careggi, Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Belardinelli
authors.affiliation: Direzione Sanitaria, AOU Careggi, Firenze, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Matarrese
authors.affiliation: SOD Geriatria, AOU Careggi, Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
authors.affiliation: Direzione Sanitaria, AOU Careggi, Firenze, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Rafanelli
authors.affiliation: Direzione Sanitaria, AOU Careggi, Firenze, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gusinu
authors.affiliation: SOD Geriatria, AOU Careggi, Firenze, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D033183:Interdisciplinary Communication; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010348:Patient Care Team; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome