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Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course.

Methods

We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1–2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.

Results

The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01–1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04–2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22–5.91, p ≤ 0.001).

Conclusions

After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.

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Authors and Affiliations

  1. Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands

    E. C. Folbert, J. H. Hegeman & D. van der Velde

  2. Department of Finance and Organization, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands

    R. Gierveld

  3. ZGT Academy, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands

    J. J. van Netten

  4. Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands

    H. J. Ten Duis

  5. Department of Geriatric Medicine, University Medical Centre Groningen, Goningen, Leydenacademy on Vitality and Aging, Leiden, The Netherlands

    J. P. Slaets

Authors
  1. E. C. Folbert
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  2. J. H. Hegeman
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  3. R. Gierveld
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  4. J. J. van Netten
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  5. D. van der Velde
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Correspondence to E. C. Folbert.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

The Medical Ethical Committee of Medisch Spectrum Twente (MST) at Enschede, the Netherlands declared that this study does not meet the criteria necessary for an assessment by a medical ethical committee according to Dutch law. This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants (or patient proxy) included in the study.

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Folbert, E.C., Hegeman, J.H., Gierveld, R. et al. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg 137, 507–515 (2017). https://doi.org/10.1007/s00402-017-2646-6

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