Mathurin Gomez1, Clément Marc2, Abdelhafid Talha2, Nicolas Ruiz2, Sophie Noublanche3, André Gillibert4, Sara Bergman2, Louis Rony2, Vincent Maynard5, Laurent Hubert2. 1. Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France. Electronic address: mathuringomez@icloud.com. 2. Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France. 3. Soins de Suite et Réadaptation, CHU Angers, 4, rue Larrey, Angers 49000, France. 4. Département de biostatistique et de recherche clinique, CHU Rouen, 1, rue de Germont, Rouen 76000, France. 5. Département d'Anesthésie Réanimation, CHU Angers, 4, rue Larrey, Angers 49000, France.
Abstract
INTRODUCTION: The medical and economic impact of treating pertrochanteric hip fractures is growing. We hypothesized that fast track surgery of pertrochanteric fractures would reduce the length of stay (LOS) without compromising the quality of care. MATERIALS AND METHODS: This was a prospective, observational, single-center cohort study conducted between 2014 and 2016 at the Angers Teaching Hospital in France. The enrolled patients had an isolated A1 or A2 proximal femur fracture (AO classification) that was treated surgically by intramedullary nailing and required post-acute rehabilitation (PAR) care. The exposed FT cohort was transferred into the PAR pathway on postoperative day 1. The non-exposed (control) group was provided with postoperative care in the surgery unit before transfer to PAR. The primary outcome was the total LOS (LOS in surgery+LOS in PAR). The secondary objectives were to determine the immediate survival, 1-year survival, postoperative complications and average cost of hospitalization. RESULTS: The study enrolled 109 patients initially, with 54 patients eligible for analysis after matching (27 pairs). The LOS in PAR and total LOS were 45.85±19.24 days and 48.56±19.36 days in the FT group (n=27), and 68.41±48.77 days and 77.85±48.80 days in the control group (n=27). Thus the LOS in PAR and total LOS were significantly lower in the FT group (p=0.022, p=0.003). There was no significant difference in the number of early deaths, complications, and 1-year survival without rehospitalization between cohorts. The mean cost per patient was lower in the FT cohort. DISCUSSION: The FT pathway has already been adopted in orthopedics. For patient who suffer a hip fracture, it contributes to reducing the total LOS without negatively impacting the quality of care. Early health economics studies support this care pathway. CONCLUSION: The FT approach to treating pertrochanteric fractures reduces total LOS without increasing mortality or complication rates. The 1-year survival is comparable. LEVEL OF EVIDENCE: IIB, Exposed/Unexposed cohort.
INTRODUCTION: The medical and economic impact of treating pertrochanteric hip fractures is growing. We hypothesized that fast track surgery of pertrochanteric fractures would reduce the length of stay (LOS) without compromising the quality of care. MATERIALS AND METHODS: This was a prospective, observational, single-center cohort study conducted between 2014 and 2016 at the Angers Teaching Hospital in France. The enrolled patients had an isolated A1 or A2 proximal femur fracture (AO classification) that was treated surgically by intramedullary nailing and required post-acute rehabilitation (PAR) care. The exposed FT cohort was transferred into the PAR pathway on postoperative day 1. The non-exposed (control) group was provided with postoperative care in the surgery unit before transfer to PAR. The primary outcome was the total LOS (LOS in surgery+LOS in PAR). The secondary objectives were to determine the immediate survival, 1-year survival, postoperative complications and average cost of hospitalization. RESULTS: The study enrolled 109 patients initially, with 54 patients eligible for analysis after matching (27 pairs). The LOS in PAR and total LOS were 45.85±19.24 days and 48.56±19.36 days in the FT group (n=27), and 68.41±48.77 days and 77.85±48.80 days in the control group (n=27). Thus the LOS in PAR and total LOS were significantly lower in the FT group (p=0.022, p=0.003). There was no significant difference in the number of early deaths, complications, and 1-year survival without rehospitalization between cohorts. The mean cost per patient was lower in the FT cohort. DISCUSSION: The FT pathway has already been adopted in orthopedics. For patient who suffer a hip fracture, it contributes to reducing the total LOS without negatively impacting the quality of care. Early health economics studies support this care pathway. CONCLUSION: The FT approach to treating pertrochanteric fractures reduces total LOS without increasing mortality or complication rates. The 1-year survival is comparable. LEVEL OF EVIDENCE: IIB, Exposed/Unexposed cohort.
Authors: Alexander M Keppler; Jenny Holzschuh; Daniel Pfeufer; Johannes Gleich; Carl Neuerburg; Christian Kammerlander; Wolfgang Böcker; Julian Fürmetz Journal: Eur J Trauma Emerg Surg Date: 2021-12-21 Impact factor: 2.374