Impact of a Multidisciplinary Algorithm on Early Complications After Hip Fracture Surgery: A Retrospective Time-Series Study.

Anesthesia & Analgesia Pub Date : 2026-04-27 DOI:10.1213/ane.0000000000008055

Michele Carella,Florian Beck,Ambre Tanke,Vincent L Bonhomme

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Abstract

BACKGROUND Hip fracture carries high morbidity in elderly patients. While most efforts focus on single perioperative measures, we assessed whether a coordinated multidisciplinary algorithm could reduce early postoperative complications (EPOCs) within 7 days. The Advise, Surgery, Analgesia, Pharmacology (ASAP) bundle comprises four components: orthogeriatric consultation (Advise), surgery within 12 hours (Surgery), supra-inguinal fascia iliaca block (SFIB; Analgesia), and chronic therapy adjustment (Pharmacology). METHODS In this retrospective, single-center interrupted time-series cohort study (January 2017-December 2022), we compared hip fracture patients admitted pre-ASAP (January 1, 2017-December 31, 2019) versus post-ASAP (January 1, 2020-December 31, 2022). Following ethics approval, we conducted interrupted time-series analysis of 7-day EPOC rates, stratified by Clavien-Dindo grades: all complications (1-4) and major complications (2-4). Kaplan-Meier and Cox proportional hazards models evaluated cumulative incidence and hazard ratios (HRs). RESULTS Among 845 patients (480 pre-ASAP, 365 post-ASAP), all EPOCs declined immediately after ASAP implementation (P = .032) with a sustained negative trend over time (P = .008), and major EPOCs also decreased immediately (P < .001) with a flatter subsequent trend (P = .20). Kaplan-Meier curves confirmed a lower cumulative incidence of both all and major complications post-ASAP (log-rank P < .001). ASAP reduced the hazard for all EPOCs (HR, 0.58; 95% confidence interval [CI], 0.49-0.68) and major EPOCs (HR, 0.60; 95% CI, 0.49-0.73). Early surgery and SFIB each independently predicted fewer all EPOCs, whereas only early surgery predicted fewer major EPOCs. CONCLUSIONS Implementation of the ASAP bundle significantly lowered EPOCs after hip fracture surgery. Early surgery and SFIB were especially impactful, supporting broader adoption of multimodal perioperative strategies in elderly patients.

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多学科算法对髋部骨折术后早期并发症的影响：回顾性时间序列研究。

背景：髋部骨折在老年患者中发病率很高。虽然大多数努力都集中在单一的围手术期措施上，但我们评估了协调的多学科算法是否可以减少7天内的早期术后并发症（epoc）。建议，手术，镇痛，药理学（ASAP）包包括四个部分：骨科会诊（建议），12小时内手术（外科），腹股沟上筋膜髂阻滞（SFIB；镇痛）和慢性治疗调整（药理学）。方法在这项回顾性、单中心中断时间序列队列研究（2017年1月- 2022年12月）中，我们比较了髋部骨折患者在asap前（2017年1月1日- 2019年12月31日）和在asap后（2020年1月1日- 2022年12月31日）入院。伦理批准后，我们对7天EPOC发生率进行了中断时间序列分析，按Clavien-Dindo分级：所有并发症（1-4）和主要并发症（2-4）分层。Kaplan-Meier和Cox比例风险模型评估了累积发生率和风险比（hr）。结果845例患者（ASAP术前480例，ASAP后365例），所有患者的epc均在ASAP实施后立即下降（P = 0.032），且随时间呈持续的负趋势（P = 0.008），主要epc也立即下降（P < 0.001），且后续趋势平缓（P = 0.20）。Kaplan-Meier曲线证实，asap术后所有并发症和主要并发症的累积发生率均较低（log-rank P < 0.001）。ASAP降低了所有epc的风险（HR, 0.58； 95%可信区间[CI]， 0.49-0.68）和主要epc的风险（HR, 0.60; 95% CI, 0.49-0.73）。早期手术和SFIB各自独立预测所有epc较少，而仅早期手术预测主要epc较少。结论应用ASAP束能显著降低髋部骨折术后eppocs。早期手术和SFIB尤其有效，支持在老年患者中更广泛地采用多模式围手术期策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Anesthesia & Analgesia

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