What is the impact of a fast-track pathway on length of stay for adult patients with a hip fracture? A systematic review

Publication Name

Archives of Orthopaedic and Trauma Surgery


Introduction: In orthopaedic surgery, hip fracture patients represent one of the largest cohorts. Hip fracture is a serious injury commonly occurring in frail and elderly patients. Fast-track admission pathways aim to streamline patients through accident and emergency departments, resulting in shorter wait times and less negative patient outcomes. Aim: To examine the impact of a fast-track pathway on length of stay for adults admitted to an acute hospital with a hip fracture. Methods: CINAHL Plus with Full text (via EBSCO host), MEDLINE, Cochrane Library, and Embase database searches were carried out in January 2021, to find all relevant literature for this review, as well as through searching additional sources. Eligible studies were quantitative primary research, focusing on the use of fast-track admission pathway care versus usual care, for adults with a hip fracture. The assessment of study suitability, data extraction, and critical appraisal was carried out by two independent authors. A narrative analysis of the data was conducted, and data were meta-analysed using RevMan where possible. Quality appraisal of the included studies was undertaken using the EBL checklist. Results: Seven studies reporting data on 5723 patients were included. Length of stay, time to surgery, and mortality did not differ significantly between the fast-track care, and usual care. One study reported on delirium and found statistically significantly fewer encounters of delirium in fast-track care versus usual care. Four of the seven studies satisfied rigorous quality appraisal (> 75%) using the EBL. Conclusion: The fast-track pathway avoided unnecessary delays in emergency departments due to faster X-rays, direct admission to orthopaedic wards, and reduced delirium rates. However, results were unable to show the impact of fast-track on length of stay, time to surgery, and mortality.

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