Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation

Arch Orthop Trauma Surg. 2014 Sep;134(9):1261-9. doi: 10.1007/s00402-014-2057-x. Epub 2014 Jul 26.


Introduction: Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes.

Materials and methods: The prospective survey covered 493 hip fracture patients 65 years of age or older that were treated either before "Usual Care = (UC)" or after "Co-Managed-Care = (CMC)" implementation of the care pathway. Primary outcome was length of stay (LoS). Secondary outcomes were 1-year mortality and change in residential status from prefracture baseline to 1-year after surgery. Data were analysed by descriptive and interferential statistics and adjustment for baseline differences amongst the two patient groups was done.

Results: Patients in the CMC sample had more preexisting comorbidities (CCI 2.5 versus 2.1). Prior to the fracture, a larger proportion amongst them needed help in ADL (49 versus 26%), and they were more likely to reside in a nursing home (36 versus 29%). Prefracture mobility status was equal in both samples. In the CMC sample LoS was significantly shorter (LoS 8.6 versus 11.3 days, p < 0.01) and patients were less likely to experience a complication (59 vs 73%, p < 0.01) while being in the hospital. There was no significant difference in 1-year mortality or in change of residential status.

Conclusions: A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1 year after fracture compared to prefracture baseline.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip
  • Continuity of Patient Care / standards
  • Critical Pathways*
  • Female
  • Fracture Fixation, Intramedullary
  • Health Care Surveys
  • Hemiarthroplasty
  • Hip Fractures / diagnosis
  • Hip Fractures / mortality
  • Hip Fractures / surgery
  • Hip Fractures / therapy*
  • Humans
  • Institutionalization / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Preoperative Care / methods
  • Preoperative Care / standards
  • Proportional Hazards Models
  • Prospective Studies
  • Quality Assurance, Health Care
  • Residential Facilities
  • Treatment Outcome