Medicina de Emergência: Acesso Aberto
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Multidisciplinary Approach to Hip Fracture in the Elderly: Florence Experience

Carlo Rostagno, Alessandro Cartei, Roberto Buzzi, Ferdinando Landi and Gian Franco Gensini

Since September 2011 in Orthopaedic and Trauma Centre of AOU Careggi, Florence, exists a trauma area with 75 beds managed by a team with the key figure of the internal medicine specialist as coordinator of a Multidisciplinary Working Group that will include several specialists such as Anaesthesiologists, Geriatricians, Orthopaedics. Due to the high number of elderly patients, most frequently admitted for hip fracture and often suffering from multiple co-morbidities, the clinical approach is significantly more complex than in patients undergoing elective surgery. To evaluate the effectiveness of this organization model we prospectively followed the hospital course of 297 patients with hip fracture admitted to our hospital course from September 15 2012 to November 15 2012, Results were compared with an historical sample, e.g. 235 consecutive patients admitted between January 1 and March 31 2011. In the period under investigation patients treated within 48 hours raised from 36 to 80%, while early intervention was performed in historical group in only 26%. Hospital mortality was 2.3% (7/297 patients) in comparison to 3.1%. Overall incidence of severe complications has been low, less than 8% (mainly pneumonia and respiratory failure) while, despite LMWH prophylaxis, Doppler examination showed an 18% incidence of distal DVT. No proximal symptomatic DVT however was diagnosed. Mean length of hospital stay, 18.1 ± 7 days in historical sample, significantly decreased to 6.6 ± 8.9 days in September 15 2011 ± October 15 2011 and to 13.6 ± 4.7 days (p=0.0022) in November 15-December 15 2011. We suggest that an integrated evaluation at hospital arrival with careful clinical investigation, identification and stabilization of concomitant clinical problems, would allow decreasing the time to surgery, in particular in frail subjects. Moreover, clinical management by internal medicine specialists and geriatricians, other than orthopedics, should improve the ultimate outcome in patients with hip fracture.