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The Outcome of Surgically Treated Proximal Femur Fractures Managed by Ortho-anesthetic Geriatric Care Pathway: A Prospective Observational Study with 2-Year Follow-Up

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Abstract

Background

Evaluation of the ortho-anesthetic geriatric care pathway for patients with proximal femur fracture in a tertiary care referral center was done by reporting the peri-operative morbidity and mortality. Clinical and demographic predictors of mortality were also identified in this cohort.

Material and Methods

This prospective observational study was conducted between August 2017 and November 2018. Demographic, anesthetic and surgical characteristics were recorded. Telephonic post-discharge follow-up was done for a period of 2 years. Factors predicting mortality were estimated using multivariate logistic regression.

Results

The cohort was characterized by frailty, high ASA physical status, NYHA class and Charlson co-morbidity index. The delay in presentation to hospital and subsequent surgical fixation was 7 (1–8) and 8 (5–13) days, respectively. The 30, 60, 90-day, 1-year and 2-year mortality was 13.6%, 21.8%, 25.45%, 36.5% and 44%, respectively. Intra-operative blood transfusion was a predictor of 30-day mortality (OR 9.2, 95% CI 1.02–83.17; p = 0.048). Pre-operative respiratory dysfunction predicted 60-day (OR 11.245, 95% CI 1.38–91.58; p = 0.024) and 90-day (OR 11.654, 95% CI 1.91–71.1; p = 0.008) mortality. Post-operative morbidity was reported in 31 (28.1%) patients; incidence of pneumonia (n = 9), sepsis (n = 8), MI (n = 6), PTE (n = 5) and ARF (n = 3) were 8.18%, 7.27%, 5.45%, 4.54% and 2.72%, respectively.

Conclusion

Existing pathway facilitated surgical fixation with median delay of 8 days which should be shortened to 48 h. High mortality in our cohort needs to be decreased by preventing admission delays and aggressively managing co-morbidities. Acceptable benchmark goals for pre-operative optimization of lung disease and decrease in intra-operative blood transfusion need to be incorporated in existing care pathway.

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Data Availability

Data is available and it will be shared when asked by the journal.

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Acknowledgements

We would like to thank all the patients who participated in this study.

Author information

Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India

    Tanvir Samra, Kajal Jain, Vivek Kaushal, Nidhi Bhatia, B. Naveen Naik & Ajay Singh

  2. Department of Orthopedics, PGIMER, Sector 12, Chandigarh, 160012, India

    Sandeep Patel, Devendra K. Chouhan & Mandeep S. Dhillon

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  1. Tanvir Samra
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  2. Kajal Jain
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  6. B. Naveen Naik
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  9. Ajay Singh
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Contributions

All authors contributed to the study conception and design. TS and NN performed material preparation, data collection, and analysis. The first draft of the manuscript was written by TS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to B. Naveen Naik.

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Conflicts of interest

All the authors declare no potential conflicts of interest (financial or non-financial).

Informed consent

Informed consent to participate in the study was provided by participants.

Ethical approval

Approved by the Institute ethics committee (NK/3836/MD/499 dated 29–10–2017) and registered in clinical trials registry (India) CTRI/2018/03/012853 on 23–3–2018.

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Name of the institution where work was performed: Advanced trauma centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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Samra, T., Jain, K., Kaushal, V. et al. The Outcome of Surgically Treated Proximal Femur Fractures Managed by Ortho-anesthetic Geriatric Care Pathway: A Prospective Observational Study with 2-Year Follow-Up. JOIO 57, 957–966 (2023). https://doi.org/10.1007/s43465-023-00880-z

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