A comprehensive XXXX program reduces complication rates and mortality.

@entity1 @entity55 @entity26 @entity260 @entity173 @entity911 @entity293
OBJECTIVES: To evaluate the rate of @entity260 , length of stay, and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for @entity173 @entity1 (the optimized program). DESIGN: Retrospective chart review with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). @entity1 : Five hundred thirty-five consecutive @entity1 aged 40 and older (94%>or=60) hospitalized for @entity173 between January 1, 2003, and March 31, 2004. Three hundred and thirty-six @entity1 (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more-systematic approach to nutrition, fluid and @entity26 therapy, and urinary retention. RESULTS: In the intervention group, the rate of any in-hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4-0.9; P=.002). Rates of @entity911 (P=.02), @entity55 (P=.03), and @entity293 (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P=.2). CONCLUSION: The optimized @entity173 program reduced the rate of in-hospital @entity260 and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.
