Fan Jixing, Lv Yang, Xu Xiangyu, Zhou Fang, Zhang Zhishan, Tian Yun, Ji Hongquan, Guo Yan, Yang Zhongwei, Hou Guojin
Department of Orthopedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
Front Surg. 2022 Feb 24;8:816763. doi: 10.3389/fsurg.2021.816763. eCollection 2021.
Intertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures.
In this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0.
No significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 . 34.9%, < 0.001) and 48 h (80.9 . 63.5%, < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 . 44.2%, < 0.001), deep vein thrombosis (7.9 . 12.9%, = 0.049), pneumonia (3.8 . 8.0%, = 0.045) and delirium (4.1 . 9.2%, = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality.
The MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.
由于老年人口数量的增加，过去几十年间粗隆间骨折的发病率迅速上升。近年来，老年病联合管理迅速成为老年髋部骨折患者首选的临床护理模式。本研究旨在评估多学科团队（MDT）联合管理方案对老年粗隆间骨折患者的疗效。
在这项回顾性研究中，根据所采用的医疗模式将患者分为MDT组和传统骨科护理（TOC）组。2014年1月至2016年12月期间，TOC组纳入249例患者；2017年1月至2019年12月期间，MDT组纳入241例患者。收集基线数据、围手术期数据及术后并发症，并使用SPSS 21.0进行分析。
两组患者的基线特征无显著差异。与TOC组相比，MDT组患者从入院到手术的时间和住院时间显著缩短。此外，MDT组患者入院后24小时内（61.4%对34.9%，P<0.001）和48小时内（80.9%对63.5%，P<0.001）接受手术的比例显著高于TOC组。此外，与TOC组相比，MDT组患者术后并发症（25.3%对44.2%，P<0.001）、深静脉血栓形成（7.9%对12.9%，P=0.049）、肺炎（3.8%对8.0%，P=0.045）和谵妄（4.1%对9.2%，P=0.025）的比例显著降低。然而，住院死亡率和30天死亡率无显著变化。
MDT联合管理可显著缩短老年粗隆间骨折患者从入院到手术的时间和住院时间，并减少术后并发症。需要进一步研究评估该模式对患者健康结局的影响。
