Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice
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While there is a general consensus of the impact of an orthogeriatric organisation in terms of elderly patient mortality post hip fracture, it is unclear which, among these various care models, is the most optimal.
A systematic review of the literature was undertaken using the keywords “Femoral fractures or total hip replacements or Accidental, falls” and “Aged, 80 and over” and “Mortality”. The review is presented following PRISMA guidance.
Eighteen studies were identified, published between 1988 and 2015. The number of elderly subjects participating in these studies was between 37 and 951; their mean age was 82.6 ± 7.4 years, and average mortality in these studies was 17.7%.
The odds ratio (OR) and 95% CI for association between implementation of the orthogeriatric model and mortality in all patients studied were 0.85 (0.74–0.97). In the analysis by subgroup on the type of orthogeriatric model, the group “Orthogeriatric ward” gave homogenous results, with ORs and 95% CIs of 0.62 (0.48–0.80) unlike other models: “Shared care by orthopaedists and geriatricians “and “Geriatric advice in orthopaedic ward”.
Elderly patients with hip fracture admitted early into any sort of orthogeriatric models or more specifically to a dedicated orthogeriatric ward had reduced long-term mortality. This study has to be completed by RCT showing the efficacy of orthogeriatric ward compared to other models using outcomes such as quality of life or functional recovery.
KeywordsOrthogeriatric care model Systematic review Mortality Meta-analysis
Compliance with ethical standards
Pr. Bloch and Drs. Deschasse, Marquant and Moyet declare no conflict of interest. Pr. Mertl reports personal fees from Stryker, personal fees from De Puy, personal fees from Zimmer, personal fees from X-Nov and personal fees from Adler, outside the submitted work.
- 1.Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 3:1–17Google Scholar
- 3.Boddaert J, Cohen-Bittan J, Khiami F et al (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One. https://doi.org/10.1371/journal.pone.0083795
- 6.Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and metaanalyses: the PRISMA Statement. PLoS Med. https://doi.org/10.1371/journal.pmed.1000097
- 7.Cook D, Guyatt G, Laupacis A, Sackett D (1992) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102:305s–311sGoogle Scholar
- 8.Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748Google Scholar
- 20.Grund S, Roos M, Duchene W, Schuler M (2015) Treatment in a center for geriatric traumatology. Dtsch Arztebl Int 112:113–119Google Scholar
- 21.Hempsall VJ, Robertson DR, Campbell MJ, Briggs RS (1990) Orthopaedic geriatric care—is it effective? A prospective population-based comparison of outcome in fractured neck of femur. J R Coll Physicians Lond 24:47–50Google Scholar
- 24.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
- 27.Watne LO, Torbergsen AC, Conroy S et al (2014) The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med. https://doi.org/10.1186/1741-7015-12-63
- 31.Pepersack T (2013) Orthogeriatrics: supportive evidence for the process. Rev Med Brux 34:38–45Google Scholar