The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care.

Abstract

OBJECTIVE: To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures. SETTING: Acute orthopaedic ward of a large teaching hospital. DESIGN AND PARTICIPANTS: A randomised controlled trial comparing 38 Intervention patients with 33 Standard Care patients. INTERVENTION: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management. MAIN OUTCOME MEASURES: Length of stay (LOS); deaths; level of independent functioning. RESULTS: Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P < 0.01). After adjusting for other factors that could affect LOS (eg, age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P = 0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group. CONCLUSION: This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.