The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care.

OBJECTIVE

To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures.

SETTING

Acute orthopaedic ward of a large teaching hospital.

DESIGN AND

PARTICIPANTS

A randomised controlled trial comparing 38 Intervention patients with 33 Standard Care patients.

INTERVENTION: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management.

MAIN OUTCOME MEASURES: Length of stay (LOS); deaths; level of independent functioning.

RESULTS

Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P < 0.01). After adjusting for other factors that could affect LOS (eg, age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P = 0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group.

CONCLUSION

This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.