Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera / Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures

Antecedentes y objetivo: Evaluar el impacto de la aplicación de una guía clínica multidisciplinar en el proceso de atención a pacientes con fractura de cadera. Material y métodos: Estudio prospectivo pre y postintervención en una Unidad de Ortogeriatría de un hospital de segundo nivel tras implementar una guía clínica multidisciplinar de atención a la fractura de cadera. Se analizan las características basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2períodos estudiados (junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017). Resultados: Las características basales de la población fueron similares en el período preintervención (n = 455) y en el período postintervención (n = 456). La edad media de los pacientes fue 84,8 ± 6,8 años y un 70,8% eran mujeres. La aplicación de la guía clínica multidisciplinar produjo una reducción de la estancia media (16,9 días vs. 15,6 días, p = 0,014) y mejoró la prescripción del tratamiento de la osteoporosis (51,6% vs. 88%, p < 0,001), y redujo los episodios de delirio (44% vs. 31,2%, p < 0,001), broncoespasmo (18,3% vs. 12%, p = 0,019), insuficiencia cardíaca (20% vs. 11,5%, p < 0,001) y enfermedad pulmonar obstructiva crónica agudizada (7,9% vs. 3,8%, p = 0,017). Observamos un incremento de las úlceras por presión al alta (2,9% vs. 9%, p = 0,001). No hubo diferencias en la proporción de pacientes operados en menos de 48 h (56% vs. 61,2%, p = 0,64), en reingresos hospitalarios (6,9% vs. 5,9%, p = 0,51) ni en mortalidad (5,0% vs. 7,2%, p = 0,17). Conclusiones: La implantación de una guía clínica multidisciplinar mejoró aspectos del proceso de atención a los pacientes con fractura de cadera (AU)

Background and objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. Materials and methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients’ baseline characteristics and the variations observed in care provided and in outcome variables in the 2periods studied (June 2015-May 2016 and June 2016-May 2017). Results: The baseline characteristics of the population were similar in the pre-intervention period (n=455) compared to the post-intervention period (n=456). Patients’ mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs 15.6 days, p=.014); improved osteoporosis treatment prescribing (51.6% vs 88%, p<.001); and reduced episodes of delirium (44% vs 31.2%, p<.001), bronchospasm (18.3% vs 12%, p=.019), heart failure (20% vs 11.5%, p<.001), and COPD exacerbation (7.9% vs 3.8%, p=.017). We observed an increase in pressure ulcers at discharge (2.9 vs 9%, p<.001). There were no differences in the percentage of operations in less than 48hours (56% vs 61.2% p=.64), hospital readmissions (6.9% vs 5.9%, p=.51), or mortality (5.0% vs 7.2%, p=.17). Conclusions:The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture (AU)

Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures.

BACKGROUND AND OBJECTIVES: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. MATERIALS AND METHODS: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017). RESULTS: The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17). CONCLUSIONS: The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.

Resultados de la técnica de Regnauld para el tratamiento del hallux valgus y el hallux rigidus en 147 casos a los 3 años / Results at 3 years of Regnauld's technique for the treatment of hallux valgus and hallux rigidus in 147 cases

Objetivo: Evaluar los resultados radiológicos, clínicos y funcionales a los 3 años de evolución en pacientes intervenidos quirúrgicamente para la corrección del hallux valgus y el hallux rigidus mediante la técnica de Regnauld. Material y método: Estudio descriptivo retrospectivo de 131 pacientes (147 casos) intervenidos mediante la técnica de Regnauld entre los años 2003 y 2006. Se revisaron 101 mujeres, 30 varones, 16 bilaterales. Edad media de 70 años. Seguimiento medio de 3 años. Se asociaron otros gestos quirúrgicos en 73 casos. Antes y tras la cirugía se valoró el estado clínico y funcional con el test de la escala AOFAS (American Orthopaedic Foot & Ankle Society) y se midieron los ángulos metatarsofalángico (AMTF), intermetatarsal (IM) y DASA (distal articular set angle ‘ángulo articular distal’). Resultados: Corrección del AMTF: 16,6°, del IM: 2° y del DASA: 1,7°. La puntuación en la escala AOFAS mejoró de 39,6 a 85,4. Resultados: En la escala subjetiva, las valoraciones fueron excelentes (25%), buenas (68%), aceptables (5%) y malas (2%). Resultados En el 4,7% hubo recidivas; en el 2% hubo dolor moderado, sin casos de hallux rigidus, hallux varus ni infección; no hubo ninguna reintervención.ConclusionesLos resultados a medio plazo son satisfactorios, con un bajo porcentaje de complicaciones. La técnica permite acortar la primera falange, corregir rotaciones, reducir los AMTF y DASA, mantener la congruencia y la integridad articular y recuperar su funcionalidad (AU)

Purpose: To assess radiological, clinical and functional results at 3 years’ evolution of patients subjected to surgical correction of hallux valgus and hallux rigidus by means of the Regnauld technique. Materials and Methods: Descriptive retrospective study of 131 patients and 147 cases operated through the Regnauld technique between 2003 and 2006. One hundred and one females and 30 males were reviewed; 16 cases were bilateral. Mean age was 70 years. Mean follow-up was 3 years. Additional surgical maneuvers were used in 73 cases. Before and after surgery, an assessment was made of the patients’ clinical and functional status using both the AOFAS and a subjective scale; measurements were taken of the metatarsophalangeal (MTP), intermetatarsal (IM) and distal articular set angles (DASA). Results: The degrees of correction achieved were 16.6° for the MTP angle, 2° for the IM angle and 1.7° for the DASA angle. Scores on the AOFAS scale improved from 39.6 to 85.4 points. On the subjective scale, 25% of cases rated their result as excellent, 68% as good and 2% as poor. As far as complications were concerned, there were 4.7% recurrences, 2% instances of moderate pain with no cases of hallux rigidus, hallux varus or infection. There were no reoperations. Conclusions: The technique makes it possible to shorten the first phalanx, correct rotations, reduce the MTP and DASA angles, preserve the joint's congruence and integrity los AMTF y DASA and regain its function (AU)