SHM Converge Scientific Abstract ePoster Gallery-Novel Perioperative Pathway for Acute Geriatric Hip Fracture Patients

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This report describes a novel multidisciplinary perioperative pathway for acute geriatric hip fracture patients aimed at improving outcomes such as time to operating room, delirium, length of stay, and 30-day readmissions. The pathway combines regional anesthesia, an enhanced recovery/opioid-sparing approach, expedited preoperative medical evaluation, and guideline-directed cardiology consultation, with collaboration across anesthesia, orthopedic surgery, medicine, hematology, endocrinology, vascular medicine, physical therapy, nutrition, and emergency medicine.<br /><br />The pathway emphasizes several key elements: nerve block within 2 hours of admission, carbohydrate drinks, anemia treatment, and surgery within 24 hours. Data from July 2022 to June 2023 were analyzed after COVID restrictions ended and additional pathway interventions were added.<br /><br />Results showed promising trends. Compared with other academic medical centers, the patient cohort had a higher case mix index (2.8 vs 2.5), zero observed mortality, and a shorter average length of stay (7 vs 8 days). Although not statistically significant, 30-day readmissions decreased over the year, from 15% in Q1 to 6.3% in Q4. Length of stay also trended downward. A significantly greater proportion of patients reached the operating room within 24 hours of emergency department or outside hospital presentation. There were also trends toward earlier physical therapy, less need for cardiology consultation, and wider use of carbohydrate drinks and nerve blocks.<br /><br />The authors conclude that the pathway may reduce delirium, readmissions, and length of stay, likely through faster surgery and improved perioperative care. Future work will evaluate these trends over a longer period and assess whether the pathway can reduce delays among outside-hospital transfers.

Asset Subtitle

Lily Ackermann

Meta Tag

Author List Eric S. Schwenk, Howard Weitz, Jenna Fiore, Lily Ackermann

Category Innovations

Concept Multidisciplinary Perioperative Pathway

Concept Geriatric Hip Fracture

Concept Time to Surgery

Concept Operating Room Access

Concept Nerve Block

Distinguished Finalist

Presenter Organization Thomas Jefferson University Hospital

Presenting Author Lily Ackermann

Track Perioperative

Keywords

geriatric hip fracture

perioperative pathway

regional anesthesia

enhanced recovery

opioid-sparing

delirium prevention

time to surgery

length of stay

30-day readmission

multidisciplinary care

Multidisciplinary Perioperative Pathway

Geriatric Hip Fracture

Time to Surgery

Operating Room Access

Nerve Block