| Objective:To observe the clinical efficacy of multidisciplinary team(MDT)treatment in enhanced recovery after surgery(ERAS)for the geriatric intertrochanteric fractures.Methods:According to the inclusion and exclusion standards,the clinical data of 151 elderly patients with hip fracture managed by MDT approach under the guidance of ERAS concept between August 2016 and December 2019(MDT group)and 62 patients managed by traditional orthopedics approach between January 2014and July 2016(control group)were retrospectively collected.Baseline characteristics of two groups including gender,age,fracture type,surgical procedure,hemoglobin(Hb)concentration,number of comorbidities and clinical outcomes including the rate of patients received consultation or transfer,rate of transfusion,time to surgery,rate of surgery within 24h,48h and 72h,operation time,postoperative hospitalization stay,length of hospitalization stay,hospitalization expense,rate of loss to follow-up and mortality during hospitalization,30-day mortality and 90-day mortality after operation were calculated and compared between the two groups by statistical software to analyze the curative effect of multidisciplinary team(MDT)treatment in ERAS for the geriatric intertrochanteric fractures.Results:There was no significant difference in gender,age,fracture type,surgical procedure and hemoglobin(Hb)concentration between the two groups(P>0.05).However,the number of comorbidities in the MDT group was significantly higher than that in the control group(Z=-4.911,P=0.000).Compared to the control group,patients in MDT group received less traditional geriatrics consultation(x~2=6.960,P=0.008)while the differences among other consultation comparisons between the two groups were not statistically significant(P>0.05).The rates of patients who received transfers and transferred into ICU were both significantly higher than those in control group(x~2=4.292,P=0.038;x~2=5.028,P=0.025).The time to surgery,operation time,postoperative hospitalization stay,and length of hospitalization stay in MDT group were significantly less than those in control group(Z=-2.767,P=0.006;Z=-2.155,P=0.031;Z=-2.001,P=0.045;Z=-2.285,P=0.022),but the proportions of patients who received surgery within 24h,48h,and 72h in MDT group was significantly higher than those in control group(x~2=5.748,P=0.017;x~2=4.054,P=0.044;x~2=7.599,P=0.006).However,the rate of transfusion and hospitalization expenses in MDT group were both significantly higher than those in control group(x~2=10.986,P=0.001;Z=-5.061,P=0.000).The survival information of5 patients missed in MDT group and control group respectively and there were no significant differences in the rate of loss to follow-up,mortalities at hospitalization,1month and 3 months after operation between the two groups(P>0.05).Conclusion:The MDT organized and constructed in this study was an effective model for the specific application of ERAS concept in the management of elderly patients with intertrochanteric fractures.The 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 can and to improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.The MDT model in this study provided clinicians with a management strategy for elderly patients with intertrochanteric fractures,and provided a reference for the construction of MDT under the ERAS concept for elderly patients with intertrochanteric fractures and other surgical patients in an aging society. |
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