The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults
- 49 Downloads
Treatment of older adults with hip fracture is a healthcare challenge. Orthogeriatric comanagement that is an integrated model of care with shared responsibility improves time to surgery and reduces the length of hospital stay and mortality compared with orthopedic care with geriatric consultation service and usual orthopedic care, respectively.
Treatment of fractures in older adults is a clinical challenge due partly to the presence of comorbidity and polypharmacy. The goal of orthogeriatric models of care is to improve clinical outcomes among older people with hip fractures. We compare clinical outcomes of persons with hip fracture cared according to orthogeriatric comanagement (OGC), orthopedic team with the support of a geriatric consultant service (GCS), and usual orthopedic care (UOC).
This is a single-center, pre-post intervention observational study with two parallel arms, OGC and GCS, and a retrospective control arm. Hip fracture patients admitted to the trauma ward were assigned by the orthopedic surgeon to the OGC (n = 112) or GCS (n = 108) group. The intervention groups were compared each with others and both with the retrospective control group (n = 210) of older adults with hip fracture. Several clinical indicators are considered, including time to surgery, length of stay, in-hospital, and 1-year mortality.
Patients in the OGC (OR 2.62; CI 95% 1.40–4.91) but not those in the GCS (OR 0.74; CI 95% 0.38–1.47) showed a higher probability of undergoing surgery within 48 h compared with those in the UOC. Moreover, the OGC (β, − 1.08; SE, 0.54, p = 0.045) but not the GCS (β, − 0.79; SE, 0.53, p = 0.148) was inversely associated with LOS. Ultimately, patients in the OGC (OR 0.31; CI 95 % 0.10–0.96) but not those in the GCS (OR 0.37; CI 95% 0.10–1.38) experienced a significantly lower 1-year mortality rate compared with those in the UOC. All analyses were independent of several confounders.
Older adults with hip fracture taken in care by the OGC showed better clinical indicators, including time to surgery, length of stay and mortality, than those managed by geriatric consultant service or usual orthopedic care.
KeywordsHip fracture Orthogeriatric Outcomes Models of care Mortality
Compliance with ethical standards
The study was conducted in accordance with the declaration of Helsinki and approval was obtained from the ethics committee of the regional healthcare system with registration number 2257/14.
Conflicts of interest
- 5.Marcantonio ER, Flacker JM, Michaels M, Resnick NM (2000) Delirium is independently associated with poor functional recovery after hip fracture. 48:618–624Google Scholar
- 8.Khasraghi FA, Lee EJ, Christmas C, Wenz JF (2003) The economic impact of medical complications in geriatric patients with hip fracture. Orthopedics 26:49–53Google Scholar
- 11.Giusti A, Barone A, Razzano M, Pioli G (2011) Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med 47:281–296Google Scholar
- 13.Handoll HH, Cameron ID, Mak JC, Finnegan TP (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 7(4):Cd007125Google Scholar
- 18.Middleton M, Wan B, da Assunçao R (2017) Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing 46:465–470Google Scholar
- 25.Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR, Dimitri K, Marsh A (1998) The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care. Med J Aust 169:515–518Google Scholar
- 27.Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF Sr (2005) Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv 14:27–31Google Scholar
- 29.Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, Hoang-Kim A, Mendelson D, Zuckerman J, Leung F, Burton J, Moran C, Parker M, Giusti A, Pioli G, Goldhahn J, Kates SL, Investigation performed with the assistance of the AOTrauma Network (2013) Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury 44:1403–1412CrossRefGoogle Scholar
- 30.Khan R, Fernandez C, Kashifl F, Shedden R, Diggory P (2002) Combined orthogeriatric care in the management of hip fractures: a prospective study. Ann R Coll Surg Engl 84:122–124Google Scholar
- 32.Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E, Tomlinson G, O'Rourke K, Goldlist B (2002) Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. CMAJ 167:25–32Google Scholar
- 39.Tarazona-Santabalbina FJ, Belenguer-Varea A, Rovira-Daudi E, Salcedo-Mahiques E, Cuesta-Peredó D, Doménech-Pascual JR, Salvador-Pérez MI, Avellana-Zaragoza JA (2012) Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality. Clinics 67:547–556CrossRefGoogle Scholar