The impact of implementation of palliative non-operative management on mortality of surgically treated geriatric hip fracture patients

Abstract text (incl. references and figure legends)

Background

Surgical care is crucial for regaining mobility for hip fracture patients. However, the post-operative outcomes are generally poor, with a serious risk of severe complications. Patients with various risk factors or multiple comorbidities are frail geriatric patients. Since August 1st 2020, in our hospital, these patients can opt for a palliative, non-operative management. The hypothesis is that the post implementation surgically treated hip fracture population will be less frail followed by a decrease in mortality and morbidity and therefore the burden of care at the traumageriatric ward.

Methods

This retrospective cohort study was conducted between 02-2019 and 02-2022. Patients aged 70 years older with a hip fracture undergoing surgery were included to give a comparison between hip fracture patients before and after implementation of the palliative, non-operative management. The primary endpoint was in-hospital mortality; secondary endpoints were 1-year mortality, post-operative complications, length of stay, ICU admission and readmission.

Results

Eventually, 1035 surgically treated patients were included, 550 patients in the pre-implementation cohort, and 485 patients post-implementation. After implementation, there was no significant decrease in in-hospital mortality (2.9% vs 1.4%, p=0.139) and 1-year mortality (16.5% vs. 15.7% p=0.735). There was a significant decrease in admissions to the ICU after P-NOM implementation (3.5% vs. 1.2%, p=0.025). There were no significant differences in incidence of post-operative complications, readmissions, or length of stay.

Conclusion

The implementation of the palliative, non-operative management does not lead to a significant decrease in mortality, post-operative complications and readmissions. Therefore, we think that the surgically treated hip fracture population is not overall less frail. However, admission to the ICU and prevalence of dementia did show a significant decrease in the post-implementation cohort.

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