THE MANAGEMENT OF ELDERLY PATIENTS WITH FEMORAL FRACTURES - A RANDOMIZED 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 pa tients with proximal femoral fractures. Setting: Acute orthopaedic war d of a large teaching hospital. Design and Participants: A randomised controlled trial comparing 38 intervention patients with 33 Standard C are patients. Intervention: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a mul tidisciplinary approach versus routine hospital management. Main outco me measures: Length of stay (LOS); deaths; level of independent functi oning. 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 adjusti ng for other factors that could affect LOS (e.g. age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complicatio ns), the Intervention program was significantly predictive of shorter LOS (P=0.01). The Intervention group did not experience greater number s 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 ho spital stay for elderly patients with femoral fractures.