Perioperative multi-system optimization protocol in elderly hip fracture patients: a randomized-controlled trial
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Perioperative multi-system optimization protocol in elderly hip fracture patients: a randomized-controlled trial Un protocole d’optimisation pe´riope´ratoire multisyste´mique pour les patients aˆge´s subissant une fracture de la hanche: une e´tude randomise´e controˆle´e Sebastian Schmid, MD . Manfred Blobner, MD . Brigitte Haas, MD . Martin Lucke, MD . Markus Neumaier, MD . Aida Anetsberger, MD . Bettina Jungwirth, MD Received: 5 February 2019 / Revised: 1 July 2019 / Accepted: 2 July 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Hip fractures in elderly patients are associated with increased postoperative morbidity and mortality. We evaluated whether a perioperative multi-system optimization protocol can reduce postoperative complications in these patients. Methods Immediately after diagnosis of hip fracture, patients C 60 yr were randomized to an intervention or control group. Patients in the intervention group were admitted to our postanesthesia care unit where they were treated with goal-directed hemodynamic management, optimized pain therapy, oxygen therapy, and optimized nutrition. Patients in the control group were managed
Preliminary data for this study were presented as a poster at the ‘‘Deutscher Ana¨sthesiecongress’’ meeting, 25–27 April 2018, Nuremberg, Germany and at the meeting of the International Anesthesia Research Society 28 April–01 May 2018, Chicago, USA.
according to our usual standard of care on a regular ward. Postoperative complications during hospital stay included pre-determined cardiovascular, respiratory, neurologic, renal, or surgical events. Results The incidence of at least one postoperative complication (primary outcome) was seen in 32 of 65 (49%) controls compared with 24 of 62 (39%) in the intervention group (relative risk [RR], 0.79; 95% confidence interval [CI], 0.53 to 1.17; P = 0.23). The secondary unadjusted outcomes showed that patients in the intervention group received more Ringer’s acetate compared with controls (median difference, 1.3 L; 95% CI, 0.6 to 2.1 L; P \ 0.001), had more frequently a mean arterial pressure [ 70 mmHg (57% control vs 75% intervention; median percentage difference, 16%; 95% CI, 7 to 25%; P = 0.001), better pain control (numeric rating scale \ 4 at all postoperative measurements; 25% control vs 81% intervention; RR, 0.26; 95% CI, 0.15 to 0.43; P \
Aida Anetsberger and Bettina Jungwirth contributed equally. S. Schmid, MD M. Blobner, MD A. Anetsberger, MD B. Jungwirth, MD (&) Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Klinikum rechts der Isar, Technische Universita¨t Mu¨nchen, Ismaninger Str. 22, 81675 Munich, Germany e-mail: [email protected] B. Haas, MD Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Klinikum rechts der Isar, Technische Universita¨t Mu¨nchen, Ismaninger Str. 22, 81675 Munich, Germany
M. Lucke, MD Department of Trauma Surgery and Reconstructive Surgery, Chirurgisches Klinikum Mu¨nchen Su¨d, Munich,
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