RUI Yunfeng 1,2,3,4 , QIU Xiaodong 3,5 , ZOU Jihong 3,6 , XIE Tian 1,2,3,4 , MA Binbin 1,2,3,4 , LU Panpan 1,2,3,4 , LI Yingjuan 3,6 , LIU Songqiao 3,7 , JIN Jiyang 3,8 , DENG Chunhua 1,2,3,4 , CUI Ying 3,9 , WANG Xiaoyan 3,10 , MA Ming 3,11 , REN Liqun 3,6 , YANG Yi 3,7 , WANG Chen 1,2,3,4 , CHEN Hui 1,2,3,4
  • 1. Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 2. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 3. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 4. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 5. Department of Anesthesiology, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 6. Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 7. Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 8. Department of Imaging, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 9. Operation Room, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 10. Department of Nursing, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
  • 11. Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
RUI Yunfeng, Email: ruiyunfeng@126.com
Multidisciplinary team; geriatric hip fracture; clinical application
10.7507/1002-1892.201905017
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Objective  To observe the clinical application of multidisciplinary team (MDT) treatment in the management of geriatric hip fractures and evaluate its effectiveness. Methods  The clinical data of 76 elderly patients with hip fracture managed by MDT approach between August 2016 and February 2018 (MDT group) were retrospectively analyzed and compared with 102 patients managed by traditional orthopedics approach between January 2014 and December 2015 (conventional group). There was no significant difference in gender, age, fracture type, surgical procedure, and other general data between the two groups (P>0.05). However, the number of comorbidities in the MDT group was significantly higher than that in the conventional group (t=6.295, P=0.000), and the proportion of the number of comorbidities between the two groups was also significantly different (χ2=28.442, P=0.000). The consultation rate and transfer rate, time to surgery, rate of surgery within 2 or 3 days, operation time, postoperative hospitalization stay, length of hospitalization stay, hospitalization expense, rate of loss to follow-up, and mortality during hospitalization, 30-day mortality, 90-day mortality, and 1-year mortality after operation were compared between the two groups. Results  The rates of total consultations of the conventional group and the MDT group were 56.86% (58/102) and 56.58% (43/76), respectively, and the rates of total transferred patients were 15.69% (16/102) and 15.79% (12/76), respectively, with no significant differences (P>0.05). Among them, the proportion of patients who transferred into intensive care unit (ICU) in conventional group was significantly higher than that in MDT group and the rates of patients who received geriatric consultation or transferred into geriatric department in MDT group were both significantly higher than those in conventional group (P<0.05). There was no significant difference in rates of other department consultation or transfer between the two groups (P>0.05). The time to surgery, operation time, postoperative hospitalization stay, and length of hospitalization stay in MDT group were significantly less than those in conventional group, but the proportion of patients who received surgery within 3 days in MDT group was significantly higher than that in conventional group (P<0.05). There was no significant difference in the proportion of patients who received surgery within 2 days (χ2=2.027, P=0.155). The hospitalization expenses of total patients, femoral neck fracture, and intertrochanteric fracture subgroups in MDT group were all significantly higher than those in conventional group (P<0.05). However, there was no significant difference in hospitalization expense of subtrochanteric fracture subgroup between the two groups (Z=−1.715, P=0.086). The rate of loss to follow-up in conventional group and MDT group was 6.86% (7/102) and 3.95% (3/76), respectively, with no significant difference (χ2=0.698, P=0.403). The mortalities at hospitalization, 1 month, 3 months, and 1 year after operation in conventional group were 0, 1.05% (1/95), 3.16% (3/95), and 7.37% (7/95), respectively, and in MDT group were 0, 0, 2.74% (2/73), 6.85% (5/73), respectively, showing no significant differences in mortalities between the two groups (P>0.05). Conclusion  MDT model in the management of geriatric hip fractures has been shown to reduce time to surgery, postoperative hospitalization stay, length of hospitalization stay, operation time, and the proportion of patients who received ICU consultation or transferred into ICU. Furthermore, MDT can improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.

Citation： RUI Yunfeng, QIU Xiaodong, ZOU Jihong, XIE Tian, MA Binbin, LU Panpan, LI Yingjuan, LIU Songqiao, JIN Jiyang, DENG Chunhua, CUI Ying, WANG Xiaoyan, MA Ming, REN Liqun, YANG Yi, WANG Chen, CHEN Hui. Clinical application of multidisciplinary team co-management in geriatric hip fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1276-1282. doi: 10.7507/1002-1892.201905017 Copy

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