• F Reguant, A Arnau, J V Lorente, L Maestro, and J Bosch.
• Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain. Electronic address: freguant@althaia.cat.
• J Clin Anesth. 2019 Mar 1; 53: 11-19.

Study ObjectiveWe evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality.DesignA non-randomized intervention study with a historical control group (CG).SettingDuring the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge.Patients240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG).InterventionsCG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care.MeasurementsThe following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality.Main Results512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42-0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44-0.93) were the protective factors for mortality.ConclusionsThe multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.Copyright © 2018 Elsevier Inc. All rights reserved.

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