Fast-Track in Elderly Patients Over 60 Years of Age Undergoing Hip and Femur Procedures in a Four Hospital of the BrazilianHealth System (SUS) Study Between 2010 and 2022

Abstract

Background: The Fast Track Surgery (FTS) refers to all phases of perioperative care: preoperative, intraoperative, and postoperative strategies. Although most research has focused on adherence to medication, adherence also encompasses numerous health related behaviors. The main objective of this study was to compare the FTS in elderly individuals over 60 years of age with femur and hip fractures with the hospital’s routine conduct. The second objective was to compare the groups of each decade after 60 years of age. And the third objective was to assess with orthopedists and anesthesiologists whether they changed their conduct after participating in the FTS.

Methods: After evaluating 105 patients undergoing the hospital’s usual protocol analgesia with morphine and ICU, it was compared with 1793 patients undergoing FTS, with patients underwent spinal anesthesia with postoperative analgesia by lumbar plexus block and no ICU. The FTS protocol was evaluated in three stages: during the pre-anesthetic visit until arrival in the OR, during the surgical procedure until discharge from the PACU, and finally during the infirmary and hospital discharge. The costs of the procedures were not evaluated. Finally, the adherence of professionals to the FTS was assessed.  

Results: All departments involved in the treatment of elderly patients adhered completely to the project and reported the importance of preanesthetic visit, the explanations of design, and reduction of fasting period. Just one anesthetist completely adhered to the project. Some parameters were not evaluated in the group before the project, so they were not compared, but rather evaluated after the implementation of the FTS. For analgesia, lumbar plexus blockade was used before the procedure in 998 patients and after surgery in 795 patients, with an average duration of 22 hours. All parameters studied in 1793 patients compared with the data before the project showed a reduction from 62% to 83%.

Conclusion: In four Brazilian Health System (SUS) hospitals, high adherence by virtually all health services is an excellent stimulant for the implementation of any new procedure. However, low adherence by older anesthesiologists and new anesthesiologists completing their residencies may prevent the project from being extended to all patients. There is a great need for health managers in the Brazilian Health System to embrace and implement any new service, especially if it generates savings.