Application de l’évaluation gérontologique à la planification d’une intervention chirurgicale: l’exemple de la prise en charge de la fracture de l’extrémité supérieure du fémur

  • X. Gbaguidi
  • C. Le Guillou
  • L. Quibel
  • P. Chassagne
Article de Synthèse / Review Article
  • 89 Downloads

Résumé

Les fractures de l’extrémité supérieure du fémur (FESF) surviennent chez des patients âgés, le plus souvent fragiles ou polypathologiques. Elles sont responsables d’un taux de mortalité d’environ 25 % à un an et d’une augmentation de la dépendance des sujets dans plus d’un tiers des cas. La qualité de la prise en charge des FESF a pour but d’améliorer la survie, de préserver la qualité de vie et de maintenir l’autonomie fonctionnelle du malade. Une prise en charge multidisciplinaire est alors nécessaire pour parvenir à cet objectif en réduisant le délai séparant la fracture de l’intervention, en dépistant les conditions médicales qui exposent le malade à des complications postopératoires et en planifiant précocement la sortie du malade âgé de l’hôpital. La gestion partagée des patients entre les différents intervenants (médecins anesthésistes, chirurgiens, gériatres, soignants, etc.) est à l’origine d’unités spécialisées d’orthogériatrie. Les protocoles d’interventions pluridisciplinaires basés sur l’évaluation des malades et la mise en place de projets de soins ciblés figurent au premier plan des actions menées dans ces unités.

Mots clés

Évaluation gériatrique standardisée Fracture de l’extrémité supérieure du fémur Orthogériatrie Mortalité 

Preoperative comprehensive geriatric assessment for elderly patients: the model of hip fracture co-management

Abstract

Hip fracture occurs in old patients who are more often frail and characterized by many comorbidity. The mortality rate (within 12 months) associated with hip fractures is about 25% and about one third of patients are disabled even after surgical repair. The objectives of quality of care for hip fracture management include improvement of survival rates while preserving quality of life and functional independence as well. An interdisciplinary management is necessary to reach these goals. Staffs (including surgeons, anaesthetists, nurses and geriatricians) involve in this clinical pathway have to reduce delay from fracture event to intervention, to detect conditions that may impact on medical complications in postoperative period and to plan discharge early as possible. Models of co-management for treated patients sharing interventions between all these professionals have been developed in specific orthogeriatrics clinics. Comprehensive geriatric assessment of patients contributes to apply specific protocols of care for these frail patients.

Keywords

Comprehensive geriatric assessment Hip fracture Orthogeriatrics Mortality 

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Copyright information

© Springer 2009

Authors and Affiliations

  • X. Gbaguidi
    • 1
  • C. Le Guillou
    • 1
  • L. Quibel
    • 1
  • P. Chassagne
    • 1
  1. 1.Service de médecine interne gériatriqueCHU de RouenRouen cedexFrance

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