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Dedicated orthogeriatric service reduces hip fracture mortality

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Hip fracture is a common serious injury afflicting the geriatric population and is associated with poor clinical outcomes, functional and walking disabilities and high 1-year mortality rates. A multidisciplinary approach has been shown to improve outcomes of geriatric patients with fragility fracture.

Aims

We piloted a dedicated orthogeriatric service for hip fracture patients to determine if the service facilitated a change in major patient outcomes, such as mortality, length of stay and dependency.

Methods

A dedicated orthogeriatrics service for hip fracture was established as a collaborative project between the Department of Geriatric Medicine and Department of Orthopaedic Surgery at a university teaching hospital. Orthogeriatrics service data were collected prospectively on an orthogeriatric filemaker database from July 2011 to July 2012 (N = 206). Data were compared to previously recorded data (Irish Hip Fracture Database) on a cohort of hip fracture patients admitted to the same orthopaedic trauma unit from July 2009 to July 2010 (N = 248).

Results

Patients in the orthogeriatric service group experienced significant reductions in 1-year mortality (χ2 = 13.34, P < 0.001), length of acute hospital stay (U = −3.77, P < 0.001) and requirements for further rehabilitation (χ 2 = 26.59, P < 0.001). Patients in the pre-service establishment group were significantly more dependent following their fracture than the patients in the orthogeriatric service group (χ 2 = 5.34, P = 0.021).

Conclusions

A multidisciplinary management approach to fragility fracture of the femoral neck that involves comprehensive geriatric assessment, daily medical involvement of a geriatric team and specialised follow-up assessment leads to a significant reduction in mortality and improved outcomes.

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Authors and Affiliations

  1. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    C. Y. Henderson

  2. Department of Medicine, Division of Geriatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland

    E. Shanahan, M. O’Connor, D. Lyons & J. P. Ryan

  3. Department of Trauma and Orthopaedics, University Hospital Limerick, Limerick, Ireland

    A. Butler & B. Lenehan

Authors
  1. C. Y. Henderson
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  2. E. Shanahan
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  3. A. Butler
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  4. B. Lenehan
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  5. M. O’Connor
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  6. D. Lyons
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  7. J. P. Ryan
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Corresponding author

Correspondence to J. P. Ryan.

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Funding source

Author CY Henderson would like to acknowledge the summer student scholarship from Merck Sharpe and Dohme.

Conflict of interest

There are no conflicts of interest.

Ethical standards

Prior to the commencement of the study local ethical approval was received from the University Hospital Limerick’s Research Ethics Committee; this study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Data for this study was collected as an audit and no identifying patient factors were included.

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Henderson, C.Y., Shanahan, E., Butler, A. et al. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci 186, 179–184 (2017). https://doi.org/10.1007/s11845-016-1453-3

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  • DOI: https://doi.org/10.1007/s11845-016-1453-3

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