Revolutionizing hip fracture care in Brazil: unleashing multidisciplinary protocols’ power

Abstract

OBJECTIVE: The aim of this study was to evaluate the impact of a hip fracture multidisciplinary protocol in a Brazilian tertiary hospital, focusing on time to surgery, mortality, re-admission rates, and 6-month outcomes. METHODS: Conducted in a private hospital in Porto Alegre, Brazil, the protocol, initiated in October 2022 (group before protocol implementation [Group NP] and group after implementation [Group P]), involved a multidisciplinary team assessment within 24 h of admission, early ambulation, and discharge planning. Hospitalization data, including age, gender, comorbidities, length of stay, surgery timing, and mortality, were collected. Additionally, patient-reported outcome measures were evaluated 6 months post-discharge via phone, assessing disability (Oswestry Disability Index), pain level (back pain, Numeric Pain Rating Scale), and quality of life (general health, EQ5D-3L). RESULTS: The study included 213 hip fracture patients, with the majority (60.1%) undergoing surgery within 48 h of admission (Group NP: 51.3% vs. Group P: 64.7%, p<0.01). Six months later, patient-reported outcome measures favored Group P, showing a lower disability measured by the mean Oswestry Disability Index (22.0 vs. 28.0, p=0.02), reduced reported pain levels (back pain [3.0 vs. 3.9, p=0.04] and Numeric Pain Rating Scale median [3.5 vs. 4.5, p=0.04]), and a higher quality of life (health condition median [70.5 vs. 61.1, p=0.01] and EQ5D-3L median [0.72 vs. 0.65, p=0.02]). CONCLUSIONS: In the most recent period (2021–2023), long-term outcomes for hip fracture patients showed notable improvements, including reduced disability, more effective pain management, and enhanced quality of life, potentially reflecting the impact of protocol modifications.