BACKGROUND: Hip fracture carries high morbidity in elderly patients. While most efforts focus on single perioperative measures, we assessed whether a coordinated multidisciplinary algorithm could reduce early postoperative complications (EPOCs) within 7 days. The Advise, Surgery, Analgesia, Pharmacology (ASAP) bundle comprises four components: orthogeriatric consultation (Advise), surgery within 12 hours (Surgery), supra-inguinal fascia iliaca block (SFIB; Analgesia), and chronic therapy adjustment (Pharmacology). METHODS: In this retrospective, single-center interrupted time-series cohort study (January 2017–December 2022), we compared hip fracture patients admitted pre-ASAP (January 1, 2017–December 31, 2019) versus post-ASAP (January 1, 2020–December 31, 2022). Following ethics approval, we conducted interrupted time-series analysis of 7-day EPOC rates, stratified by Clavien–Dindo grades: all complications (1–4) and major complications (2–4). Kaplan-Meier and Cox proportional hazards models evaluated cumulative incidence and hazard ratios (HRs). RESULTS: Among 845 patients (480 pre-ASAP, 365 post-ASAP), all EPOCs declined immediately after ASAP implementation ( P = .032) with a sustained negative trend over time ( P = .008), and major EPOCs also decreased immediately ( P < .001) with a flatter subsequent trend ( P = .20). Kaplan-Meier curves confirmed a lower cumulative incidence of both all and major complications post-ASAP (log-rank P < .001). ASAP reduced the hazard for all EPOCs (HR, 0.58; 95% confidence interval CI, 0.49–0.68) and major EPOCs (HR, 0.60; 95% CI, 0.49–0.73). Early surgery and SFIB each independently predicted fewer all EPOCs, whereas only early surgery predicted fewer major EPOCs. CONCLUSIONS: Implementation of the ASAP bundle significantly lowered EPOCs after hip fracture surgery. Early surgery and SFIB were especially impactful, supporting broader adoption of multimodal perioperative strategies in elderly patients.
Carella et al. (2026) studied this question.