Abstract
Background & Rationale: The peritrochanteric hip fracture or hip fracture in an elder is one of the most fatal orthopedic trauma which needs surgical correction and appropriate rehabilitation after surgery until the patient can live an independent living. This condition causes a prolonged postoperative hospital stay increases postoperative cost crowds out other patients to limited hospital bed and overloads hospital workforces. The intermediate postoperative care project has been developed between the regional and district hospitals in Chiang Rai province to increase the capability of postoperative hip fracture care in district hospitals. The hip fractures patients after surgical treatment in Chiangrai Prachanukroh Hospital will be referred back to district hospitals for inpatient rehabilitation. This was the way to decrease the postoperative hospital stay and increase clinical outcomes in elderly with hip fractures in Chiang Rai province. Objective: The objective of this study was to compare the clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project between the regional hospital and district hospitals in Chiang Rai province. Methodology: This study was a prospective cohort study recruiting hip fractures elderly patients who were assigned to intermediate postoperative care in Chiangrai Prachanukroh Hospital and district hospitals from February to June 2019. The population in this study covered 91 patients of two medical benefit schemes. There were 27 patients taken care in Chiangrai Prachanukroh Hospital and 64 patients taken care in district hospitals. Results: The average ages of the elderly patients with hip fractures taken care in Chiangrai Prachanukroh Hospital and district hospitals were 76.2 and 76.6 years respectively. Most of them (70.4 and 62.5 percent respectively) were suffered from the intertrochanteric area fractures. The percentages of the patients who were operated by the proximal femoral nail antirotation (PFNA) fixation were 59.3 and 64.1. The average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital was statistically significant lowered from 5.4 to 3.5 days (p=0.001). There were no significant differences in postoperative complications (p=0.305). The activity of daily living scores (Barthel’s index) of the elderly patients on discharge date were 13.6 and 13.3, and at 6 weeks after discharge were at 17.0 and 17.2 respectively (p=0.874). Conclusion: The clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project treated at the regional and district hospitals in Chiang Rai province were not different. The project lowered the average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital.
