{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:56:41Z","timestamp":1790391401242,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Anesthesia department"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Hip fractures are highly prevalent worldwide, primarily affecting frail elderly patients. Frailty increases the risk of complications like postoperative delirium, which negatively impacts outcomes, including morbidity and mortality. Current recommendations favor a multidisciplinary approach and effective pain control, often using preoperative peripheral nerve blocks. We aimed to evaluate a multimodal approach\u2019s efficacy in reducing postoperative delirium and complications in geriatric hip fracture patients. Methods: This study was conducted between March 2020 and June 2022. A total of 144 patients evaluated prior to the implementation of an optimized clinical pathway protocol (OCPP) were compared to 117 patients evaluated following its implementation. The protocol included early preoperative evaluation, streamlined medication adjustments, prompt surgical intervention and fascia iliaca compartment block (FICB) for analgesia. In addition, early patient mobilization and resumption of oral intake were promoted. The primary outcome was the incidence of delirium during hospitalization. Secondary outcomes were a composite of 30-day mortality or major complications, duration of stay, hospital readmission after discharge and 1-year mortality. Results: The OCPP intervention significantly reduced the incidence of postoperative delirium from 44% to 29% (a 33% relative reduction; p = 0.017), the rate of major complications or death was 14.5% in OCPP group and 25.7% in the control group (p = 0.02). Significantly more patients in the OCPP group were mobilized within 24 h (74.4% vs. 41.3% in the control group, p &lt; 0.001). The median time to ambulation was also shorter in the OCPP group: 65 h (IQR: 39\u2013115) compared to 72 h (IQR: 48\u2013119.75) in the control group (p = 0.028). No differences were observed on hospital stay and 1-year mortality. Conclusions: Among patients undergoing hip fracture repair the implementation of a OCPP significantly reduced the incidence of postoperative delirium and the rate of major complications or death. This improvement was associated with significantly earlier patient mobilization and ambulation. The OCPP was not associated with a lower hospital stay and lower rate of one-year mortality.<\/jats:p>","DOI":"10.3390\/jcm14155284","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T09:53:02Z","timestamp":1753696382000},"page":"5284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of an Optimized Clinical Pathway Protocol Including Fascia Iliaca Compartment Block on Delirium and Postoperative Complications in Elderly Hip Fracture Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Carmen","family":"Corbella-Gim\u00e9nez","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Monge-Cid","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Gallo-Carrasco","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Barros Garc\u00eda-Imhof","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"S\u00e1nchez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"D\u00edaz-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1065-9023","authenticated-orcid":false,"given":"Ignacio","family":"Vasserot","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8641-2692","authenticated-orcid":false,"given":"Maria Jos\u00e9","family":"Anadon-Baselga","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Psychiatry and Pathology, Faculty of Medicine Complutense University, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-8965","authenticated-orcid":false,"given":"Matilde","family":"Zaballos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Department of Forensic Medicine, Psychiatry and Pathology, Faculty of Medicine Complutense University, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dyer, S.M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L.A., Cameron, I.D., Sherrington, C., and Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group (2016). A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr., 16.","DOI":"10.1186\/s12877-016-0332-0"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1111\/ggi.13471","article-title":"Less than one-third of hip fracture patients return to their prefracture level of instrumental activities of daily living in a prospective cohort study of 480 patients","volume":"18","author":"Moerman","year":"2018","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_3","unstructured":"National Institute for Health and Care Excellence (2023, January 18). Delirium: Prevention, Diagnosis and Management Clinical Guideline CG103. Available online: https:\/\/www.nice.org.uk\/guidance\/cg103."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chen, Y., Liang, S., Wu, H., Deng, S., Wang, F., Lunzhu, C., and Li, J. (2022). Postoperative delirium in geriatric patients with hip fractures. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.1068278"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/anae.15291","article-title":"Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists","volume":"76","author":"Griffiths","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e015572","DOI":"10.1136\/bmjopen-2016-015572","article-title":"Protocol for validation of the 4AT, a rapid screening tool for delirium: A multicentre prospective diagnostic test accuracy study","volume":"8","author":"Shenkin","year":"2018","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1093\/ageing\/afu021","article-title":"Validation of the 4AT, a new instrument for rapid delirium screening: A study in 234 hospitalised older people","volume":"43","author":"Bellelli","year":"2014","journal-title":"Age Ageing"},{"key":"ref_9","first-page":"489","article-title":"Frailty in elderly people: An evolving concept","volume":"150","author":"Rockwood","year":"1994","journal-title":"CMAJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/anae.14840","article-title":"The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: A quality improvement study","volume":"75","author":"Chuan","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/j.1399-6576.2010.02232.x","article-title":"Reducing delirium in elderly patients with hip fracture: A multi-factorial intervention study","volume":"54","author":"Hommel","year":"2010","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1046\/j.1532-5415.2001.49108.x","article-title":"Reducing delirium after hip fracture: A randomized trial","volume":"49","author":"Marcantonio","year":"2001","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.berh.2019.03.015","article-title":"Interdisciplinary care of hip fractures: Orthogeriatric models, alternative models, interdisciplinary teamwork","volume":"33","author":"Ranhoff","year":"2019","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10195-009-0062-6","article-title":"Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: A randomized placebo-controlled study","volume":"10","author":"Mouzopoulos","year":"2009","journal-title":"J. Orthop. Traumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.bja.2017.12.042","article-title":"Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation","volume":"120","author":"Steenberg","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wennberg, P., M\u00f6ller, M., Herlitz, J., and Kenne Sarenmalm, E. (2019). Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures-effects on cognition. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1266-0"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kim Kim, S.Y., Jo, H.Y., Na, H.S., Han, S.H., Do, S.H., and Shin, H.J. (2023). The effect of peripheral nerve block on postoperative delirium in older adults undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072459"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s11916-021-00940-9","article-title":"The application of fascia iliaca compartment block for acute pain control of hip fracture and surgery","volume":"25","author":"Verbeek","year":"2021","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8503963","DOI":"10.1155\/2020\/8503963","article-title":"Fascia iliaca compartment block for perioperative pain management of geriatric patients with hip fractures: A systematic review of randomized controlled trials","volume":"2020","author":"Wan","year":"2020","journal-title":"Pain Res. Manag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1007\/s12630-019-01475-9","article-title":"Perioperative multi-system optimization protocol in elderly hip fracture patients: A randomized-controlled trial","volume":"66","author":"Schmid","year":"2019","journal-title":"Can. J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1111\/j.1532-5415.2009.02485.x","article-title":"An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients","volume":"57","author":"Alonso","year":"2009","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E170","DOI":"10.1503\/cjs.010021","article-title":"Safety of expedited-surgery protocols in anticoagulant-treated patients with hip fracture: A systematic review and meta-analysis","volume":"66","author":"You","year":"2023","journal-title":"Can. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"501651","DOI":"10.1016\/j.redar.2024.501651","article-title":"Perioperative management of the patients with hip fracture under anticoagulant or antiaggregants treatment. Consensus recommendations from the hemostasis section of SEDAR","volume":"72","author":"Cassinello","year":"2025","journal-title":"Rev. Esp. Anestesiol. Reanim. (Engl. Ed.)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/MEJ.0000000000000167","article-title":"Fascia iliaca compartment block for hip fractures: Experience of integrating a new protocol across two hospital sites","volume":"23","author":"Lees","year":"2016","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jclinane.2018.09.029","article-title":"Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture","volume":"53","author":"Reguant","year":"2019","journal-title":"J. Clin. Anesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.jtcvs.2021.05.031","article-title":"Diagnostic accuracy of \u201c4AT\u201d delirium screening tool for the postoperative cardiac surgery ward","volume":"165","author":"Chang","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5284\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:16:27Z","timestamp":1760033787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,26]]},"references-count":26,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155284"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155284","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,26]]}}}