Application of integrated management bundle incorporating with multidisciplinary measures improved in-hospital outcomes and early survival in geriatric hip fracture patients with perioperative heart failure: a retrospective cohort study

Abstract

Background In elderly, hip fracture is often complicated by perioperative heart failure, related to worse prognosis. We aimed to analyze the effects of integrated management bundle incorporating with multidisciplinary measures on in-hospital outcomes and early survival in elderly hip fracture patients with perioperative heart failure. Methods In this retrospective cohort study, a total of 421 hip fracture patients aged 65 and over who developed perioperative heart failure were included. According to different perioperative management modes applied, patients were retrospectively divided into multidisciplinary management group (Group A), including 277 patients, and integrated management bundle group (Group B), including 144 patients. The B-type natriuretic peptide (BNP) and C-reactive protein (CRP) levels, complications, length of stay, and hospitalization costs were observed and compared between two groups. Overall survival was compared by Kaplan–Meier methods. Cox regression analysis was used to identify prognostic factors associated with overall survival. Results A total of 421 patients were enrolled for analysis, including 277 in Group A and 144 in Group B. BNP and CRP levels were significantly decreased compared with admission (P < 0.05). Furthermore, BNP and CRP in Group B decreased much more than those in Group A (P < 0.05). The reductions were observed in length of stay, hospitalization costs and incidence of pulmonary infection, hypoproteinemia, and acute cerebral infarction in Group B (all P < 0.05). The Kaplan–Meier plots showed significantly superior overall survival in Group B. Integrated management bundle was independent favorable prognostic factors. Conclusions The integrated management bundle incorporating with multidisciplinary measures significantly improved the therapeutic effect of perioperative heart failure, reduced inflammatory response, and yielded better hospital outcomes. It brought better survival benefits for geriatric hip fracture patients with perioperative heart failure. The results of this study can play an important role in clinical work and provide a valuable theoretical basis for selection of management model in elderly hip fracture patients with perioperative heart failure.

Characteristics and Perioperative Outcomes of Fracture in Elderly patients with Chronic Heart Failure: A Cross-Sectional Study

“…CRP is an in ammatory marker, and increased CRP associated with adverse outcomes in patients with CHF [23]. Our previous studies have shown that perioperative heart failure is associated with in ammatory responses and traumatic stress [11]. In our study, BNP and CRP were signi cantly higher than normal in fracture patients regardless of the type of heart failure.…”

“…Increase vasoconstriction and cardiac stress by mediating the release of glucocorticoids and catecholamines, and ultimately lead to perioperative ischemia and myocardial injury. [11], the pre-existing cardiovascular risk may be exacerbated.…”

“…The mechanism of perioperative complications and mortality is extremely complex. The studies have shown that cardiac complications are related to in ammatory response and perioperative traumatic stress [11,12].…”

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

“…Unlike most hospitals, our hospital has a geriatric orthopaedic department, which consists of orthopedists, internists, rehabilitation specialists and trained nurses, and provides centralized management and 24/7 geriatric support [10]. The multidisciplinary geriatric fracture team attended ward rounds 7 days a week.…”

“…The clinical measures of evaluation and education, nutritional support, respiratory management, volume management, blood management, thrombus management, pain management and sedation, tube management and preoperative protocol were different between two perioperative management modalities. The specific measures were described in Table 1 [10].…”