Archives of Osteoporosis

, 13:131 | Cite as

The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

  • W. S. NijmeijerEmail author
  • E. C. Folbert
  • M. Vermeer
  • M. M. R. Vollenbroek-Hutten
  • J. H. Hegeman
Original Article



In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24–48 h after arrival at the hospital, while the length of hospital stay shortened.


Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation.


Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods.


A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years.


The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24–48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population.


Hip fracture Orthogeriatric Fragility fracture Aged Outcome 


Compliance with ethical standards

Conflicts of interest


Supplementary material

11657_2018_550_MOESM1_ESM.docx (69 kb)
ESM 1 (DOCX 69 kb)


  1. 1.
    Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B (2011) Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int 22:2575–2586. CrossRefPubMedGoogle Scholar
  2. 2.
    Forni S, Pieralli F, Sergi A, Lorini C, Bonaccorsi G, Vannucci A (2016) Mortality after hip fracture in the elderly: the role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Arch Gerontol Geriatr 66:13–17. CrossRefPubMedGoogle Scholar
  3. 3.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650. CrossRefPubMedGoogle Scholar
  4. 4.
    Jamal Sepah Y, Umer M, Khan A, Ullah Khan Niazi A (2010) Functional outcome, mortality and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world. Int Orthop 34:431–435. CrossRefPubMedGoogle Scholar
  5. 5.
    Folbert ECE, Smit RS, van der Velde D, Regtuijt EMM, Klaren MH, Hegeman JHH (2012) Geriatric fracture center: a multidisciplinary treatment approach for older patients with a hip fracture improved quality of clinical care and short-term treatment outcomes. Geriatr Orthop Surg Rehabil 3:59–67. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Folbert EC, Hegeman JH, Vermeer M, Regtuijt EM, van der Velde D, ten Duis HJ, Slaets JP (2017) Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int 28:269–277. CrossRefPubMedGoogle Scholar
  7. 7.
    Auais M, Morin S, Nadeau L, Finch L, Mayo N (2013) Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporos Int 24:2713–2724. CrossRefPubMedGoogle Scholar
  8. 8.
    Leng S, Chen X, Mao G (2014) Frailty syndrome: an overview. Clin Interv Aging 9:433. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49–e55. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Flikweert ER, Izaks GJ, Knobben BA et al (2014) The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial. BMC Musculoskelet Disord 15:188. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385:1623–1633. CrossRefPubMedGoogle Scholar
  12. 12.
    Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D, Blauth M (2010) Ortho-geriatric service—a literature review comparing different models. Osteoporos Int 21:637–646. CrossRefGoogle Scholar
  13. 13.
    Kates SL (2016) Hip fracture programs: are they effective? Injury 47:S25–S27. CrossRefPubMedGoogle Scholar
  14. 14.
    Daabiss M (2011) American Society of Anaesthesiologists physical status classification. Indian J Anaesth 55:111–115. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  16. 16.
    Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 405:1–40Google Scholar
  17. 17.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65PubMedGoogle Scholar
  18. 18.
    Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 75:797–798CrossRefGoogle Scholar
  19. 19.
    Kristensen MT, Foss NB, Ekdahl C, Kehlet H (2010) Prefracture functional level evaluated by the new mobility score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 81:296–302. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lau TW, Fang C, Leung F (2017) The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower. Osteoporos Int 28:791–798. CrossRefPubMedGoogle Scholar
  21. 21.
    de Palma L, Torcianti M, Meco L, Catalani A, Marinelli M (2013) Operative delay and mortality in elderly patients with hip fracture: an observational study. Eur J Orthop Surg Traumatol 28:1–6. CrossRefGoogle Scholar
  22. 22.
    Sciard D, Cattano D, Hussain M, Rosenstein A (2011) Perioperative management of proximal hip fractures in the elderly: the surgeon and the anesthesiologist. Minerva Anesthesiol 77:715–722Google Scholar
  23. 23.
    Baskaran D, Rahman S, Salmasi Y, Froghi S, Berber O, George M (2018) Effect of tranexamic acid use on blood loss and thromboembolic risk in hip fracture surgery: systematic review and meta-analysis. HIP Int 28:3–10. CrossRefPubMedGoogle Scholar
  24. 24.
    Hou G, Zhou F, Tian Y, Ji H, Zhang Z, Guo Y, Lv Y (2014) Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures. Injury 45:1932–1937. CrossRefPubMedGoogle Scholar
  25. 25.
    Adunsky A, Lichtenstein A, Mizrahi E et al (2003) Blood transfusion requirements in elderly hip fracture patients. Arch Gerontol Geriatr 36(1):75–81.
  26. 26.
    Foss NB, Kehlet H (2006) Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br 88–B:1053–1059. CrossRefGoogle Scholar
  27. 27.
    Kadar A, Chechik O, Steinberg E, Reider E, Sternheim A (2013) Predicting the need for blood transfusion in patients with hip fractures. Int Orthop 37:693–700. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Blandfort S, Gregersen M, Borris LC, Damsgaard EM (2017) Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial. Aging Clin Exp Res 29:459–466. CrossRefPubMedGoogle Scholar
  29. 29.
    Schuurmans MJ, Duursma SA, Shortridge-Baggett LM (2008) Early recognition of delirium: review of the literature. J Clin Nurs 10:721–729. CrossRefGoogle Scholar
  30. 30.
    Carpintero P, Caeiro JR, Carpintero R et al (2014) Complications of hip fractures: a review. World J Orthop.
  31. 31.
    Bliemel C, Buecking B, Hack J, Aigner R, Eschbach DA, Ruchholtz S, Oberkircher L (2017) Urinary tract infection in patients with hip fracture: an underestimated event? Geriatr Gerontol Int 17:2369–2375. CrossRefPubMedGoogle Scholar
  32. 32.
    Oh ES, Li M, Fafowora TM, Inouye SK, Chen CH, Rosman LM, Lyketsos CG, Sieber FE, Puhan MA (2015) Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review HHS public access. Int J Geriatr Psychiatry 30:900–910. CrossRefPubMedGoogle Scholar
  33. 33.
    Yassa R, Khalfaoui MY, Hujazi I et al (2017) Management of anticoagulation in hip fractures: a pragmatic approach. EFORT Open Rev 2:394–402. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    American Academy of Orthopeadic Surgeons Guideline: Management of hip fractures in the elderly (2014) Accessed 13 Oct 2018
  35. 35.

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • W. S. Nijmeijer
    • 1
    • 2
    Email author
  • E. C. Folbert
    • 1
  • M. Vermeer
    • 3
  • M. M. R. Vollenbroek-Hutten
    • 2
    • 3
  • J. H. Hegeman
    • 1
  1. 1.Department of Trauma SurgeryZiekenhuisgroep TwenteAlmeloThe Netherlands
  2. 2.Telemedicine Group, Biomedical Signals and Systems, Faculty of Electrical EngineeringUniversity of TwenteEnschedeThe Netherlands
  3. 3.ZGT Academy, Ziekenhuisgroep TwenteAlmeloThe Netherlands

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