Haugan K, et al. – The efficacy of conventional care approach was compared with fast–track care method for patients with hip fracture. The physicians of this study found insufficient evidence regarding the impact of fast–track care on mortality and readmission in patients with hip fracture. However, they noticed a significant decrease in length of stay and time to surgery with this approach.

Methods

• This study enrolled 1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or subtrochanteric).
• 788 patients were treated according to conventional care from April 2008 to September 2011.
• 1032 patients were treated according to fast–track care from October 2011 to December 2013.
• Mortality and readmission to hospital, within 365 days follow–up were considered as the primary outcome.
• The secondary outcome was the length of stay.

Results

• No statistically significant differences were reported in mortality and readmission rate between patients in the fast–track and conventional care models within 365 days after the initial hospital admission.
• The conventional care group had a higher, no statistical significant mortality HR of 1.10 (95% CI 0.91 to 1.31, p=0.326) without and 1.16 (95% CI 0.96 to 1.40, p=0.118) with covariate adjustment.
• Regarding the readmission, the conventional care group sub–HR was 1.02 (95% CI 0.88 to 1.18, p=0.822) without and 0.97 (95% CI 0.83 to 1.12, p=0.644) with adjusting for covariates.
• In patients who received fast–track care, length of stay and time to surgery was statistically significant shorter, with a mean difference of 3.4 days and 6 hours, respectively.
• At baseline between patients in the two pathways, there was no statistically significant difference in sex, type of fracture, age or Charlson Comorbidity Index score.