This research aims to evaluate the efficacy of multidisciplinary care model in the management of geriatric hip fractures before and after COVID-19 pandemic and explore the breakthrough of the clinical pathway optimization in the situation of routine epidemic prevention and control.

The elderly patients with hip fracture treated with a multidisciplinary approach in the Department of Geriatric Orthopaedics and Traumatology of Beijing Jishuitan Hospital from January 2019 to December 2020 were included. The clinical data including age, gender, fracture type, ASA score, surgical treatment rate, time from injury to emergency, time from emergency to admission, time from admission to operation, operation rate within 48 hours of admission, length of stay, incidence of perioperative complications and in-hospital mortality were collected retrospectively and analyzed.

A total of 2275 elderly patients with hip fracture were enrolled, in which 663 males (29.1%) and 1612 females (70.9%). The average age was 79.7 y (65-105 y). There were 1219 cases of femoral neck fracture (53.6%), 1016 cases of trochanteric fracture (44.7%), and 40 cases of subtrochanteric fracture (1.8%). High ASA score accounted for 49.6%. The surgical treatment rate was 97.7%. The in-hospital mortality rate was 0.2% (4 cases). Compared with 2019, in 2020, the average time from injury to emergency was significantly longer (1.7 d VS. 3.4 d, P=0.000); the average time from emergency to admission was unchanged (23.4 h VS. 24.0 h, P=0.109); the average time from admission to operation increased slightly (30.7 h VS. 38.3 h, P=0.000); the operation rate within 48 hours of admission decreased (82.1% VS. 72.4%, P=0.000); the average length of stay was slightly longer (4.1 d VS. 4.3 d, P=0.005); the incidence of perioperative complications increased significantly (16.9% VS. 22.5%, P=0.001), mainly reflected in the increased incidence of bedsore, pneumonia and urinary tract infection.

"Green Pathway" with a multidisciplinary approach is efficient in the management of geriatric hip fractures with an extremely low in-hospital mortality. Effective shortening the waiting time before operation might reduce the incidence of perioperative complications.