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?
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.
KeywordsHip fracture Orthogeriatric Fragility fracture Aged Outcome
Compliance with ethical standards
Conflicts of interest
- 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. https://doi.org/10.1016/j.archger.2016.04.014 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1177/2151458512444288 CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1007/s00198-016-3711-7 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s00198-013-2390-x CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1186/1471-2474-15-188 CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1016/S0140-6736(14)62409-0 CrossRefPubMedGoogle Scholar
- 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
- 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
- 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. https://doi.org/10.1016/S0167-4943(02)00059-6
- 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. https://doi.org/10.1007/s40520-016-0587-5 CrossRefPubMedGoogle Scholar
- 30.Carpintero P, Caeiro JR, Carpintero R et al (2014) Complications of hip fractures: a review. World J Orthop. https://doi.org/10.5312/wjo.v5.i4.402
- 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. https://doi.org/10.1002/gps.4233 CrossRefPubMedGoogle Scholar
- 34.American Academy of Orthopeadic Surgeons Guideline: Management of hip fractures in the elderly (2014) https://www.aaos.org/Reasearch/guidelines/HipFxGuideline_rev.pdf. Accessed 13 Oct 2018
- 35.Richtlijn proximale femurfracturen (2016) https://richtlijnendatabase.nl/richtlijn/prixmale_femurfracturen/proximale_femurfracturen_-_startpagina.html. Accessed 13 Oct 2018