Dedicated orthogeriatric service reduces hip fracture mortality
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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.
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.
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).
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 (χ2 = 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 (χ2 = 5.34, P = 0.021).
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.
KeywordsOrthogeriatric Fragility fracture Neck of femur Hip fracture Comprehensive geriatric assessment
- 1.Central Statistics Office (2012) “Profile 2 Older and Younger—an age profile of Ireland”. p 11Google Scholar
- 2.Connell P, Pringle D (2004)http://www.nuim.ie/staff/dpringle/ncaop-report.pdf. Accessed 6 July 2013
- 7.British Orthopaedic Association (2007) The care of patients with fragility fracturesGoogle Scholar
- 9.Handoll HHG, Cameron ID, Mak JCS, Finnegan TP (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 4:CD007125Google Scholar
- 23.Mittal M, Cosker T, Ghandour A, Roy S, Gupta A, Johnson S (2006) Orthogeriatric service—does it work? J Bone Joint Surg Br 88-B:43Google Scholar
- 30.Zlowodzki M, Tornetta P, Haidukewych G, Hanson BP, Petrisor B, Swiontkowski MF et al (2009) Femoral neck fractures: evidence versus beliefs about predictors of outcome. Orthopedics 32(4)Google Scholar