Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients.

To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48-0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.

Evaluación de la implantación de un bundle para la prevención de la infección de localización quirúrgica en artroplastia de rodilla y cadera en un hospital universitario / No disponible

Objetivo: Analizar el resultado de la implantación de un Bundle para la prevención de infección de localización quirúrgica (ILQ) en artroplastia de rodilla y cadera. Material y métodos: Estudio de intervención antes-después. Intervención: Bundle. Determinaciones: incidencia acumulada (IA) de ILQ y cumplimiento del Bundle. La medición de la IA de ILQ se realizó mediante un sistema de vigilancia prospectiva y la medición del cumplimiento del Bundle mediante la revisión de historias clínicas. Resultados: En 2012 la IA de ILQ fue del 4,4% frente a 1,6% en 2013. El Bundle se implantó en 2013, para el cumplimiento se revisó una muestra aleatoria del 33% de los pacientes intervenidos de prótesis de rodilla y cadera ese año. El cumplimiento de cada medida fue variable. Conclusiones: Se ha evidenciado una reducción de la ILQ coincidente con la puesta en marcha del Bundle. Se han identificado puntos críticos de incumplimiento y tomado medidas para su mejora

Objetivo: Analyze the result of the implantation of a Bundle for the prevention of surgical site infection (SSI) in knee and hip arthroplasty. Material y métodos: Intervention study before-after. Intervention: Bundle. Determinations: cumulative incidence (CI) of patients with SSI and Bundle compliance. The measurement the CI of SSI was made through a prospective vigilance system and the measurement of the Bundle compliance through a review of the medical histories. Results: In 2012, CI of SSI was 4,4% versus 1,6% in 2013. The Bundle was implanted in 2013, to size the compliance was revised a random sample of 33% of the patients who received knee and hip prosthesis that year. The compliance of each measurement varied.Conclusions: A reduction of the SSI coinciding with the commissioning of the Bundle has been evidenced. Critical points of failure were identified and measures have been implemented