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Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients

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Abstract

Background

Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers.

Methods

The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected.

Results

The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80–90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23–62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators (“pre-surgical cognitive assessment”, “bone protection prescription”, “use of urinary catheter” and “start of physiotherapy”), moderate in two indicators (“surgery performed ≤ 48 h from fracture” and “discharge toward rehabilitation” and low in one (“absence of delirium on day following surgery”). Comparison with international studies suggests very different ways of providing care to HF Italian patients.

Conclusions

The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.

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Funding

No Author has to disclose any conflict of interest that could have direct or potential influence or impart bias on the work.

Author information

Authors and Affiliations

  1. Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Maria Cristina Ferrara, Ilaria Cazzulani, Chiara Gandossi & Giuseppe Bellelli

  2. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Anita Andreano, Elena Tassistro & Maria Grazia Valsecchi

  3. Orthogeriatric Unit, Circolo Hospital, Varese, Italy

    Piero Rapazzini

  4. Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy

    Amedeo Zurlo & Stefano Volpato

  5. Department of Medical Sciences, University of Ferrara, Ferrara, Italy

    Stefano Volpato

  6. Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy

    Chiara Mussi

  7. Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy

    Maurizio Corsi & Giuseppe Bellelli

  8. Orthogeriatric Unit, Policlinico S. Orsola, Bologna, Italy

    Maria Lia Lunardelli & Emilio Martini

  9. Orthopedic Unit, Carate Brianza Hospital, ASST Vimercate, Vimercate, MB, Italy

    Giuseppe Castoldi

  10. Orthogeriatric Unit, Hospital of Sondrio-ASST Valtellina e Alto Lario, Sondrio, Italy

    Francesco De Filippi

  11. Orthogeriatric Unit, S. Martino Hospital, Genoa, Italy

    Monica Pizzonia & Fiammetta Monacelli

  12. Orthogeriatric Unit, Galliera Hospital, Genoa, Italy

    Antonella Barone & Alberto Pilotto

  13. Orthogeriatric Unit, Bolzano Hospital, Bolzano, Italy

    Albert March

  14. Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy

    Andrea Ungar

  15. Orthopedic Unit, ASST Fatebenefratelli Sacco, Milan, Italy

    Roberto Capelli & Valter Galmarini

  16. Orthopedic Unit, Poliambulanza Hospital, Brescia, Italy

    Simone Franzoni & Flavio Terragnoli

  17. Department of Medicine and Rehabilitation, S. Anna Hospital, Brescia, Italy

    Angelo Bianchetti

  18. Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy

    Giuseppe Bellelli

Authors
  1. Maria Cristina Ferrara
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  2. Anita Andreano
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  3. Elena Tassistro
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  7. Chiara Mussi
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  8. Maurizio Corsi
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  27. Giuseppe Bellelli
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Consortia

for the GIOG study group

Contributions

GB contributed to the study conception and design. Material preparation, data collection and analysis were performed by ET, AA and MGV. The first draft of the manuscript was written by MCF, IC, ET, AA and GB. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Giuseppe Bellelli.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

As mentioned in the Methods section, this study received formal authorization by the Ethics Committee of the Federico II University, Naples, Italy (No. protocol 169/15).

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Federico II University of Naples (No. protocol 169/15).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Electronic supplementary material

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40520_2020_1488_MOESM1_ESM.pdf

Supplementary file1 Supplementary Table 1. GIOG Study Group. Evaluation Tool 1.0: basic data collection form. GIOG = Gruppo Italiano di Ortogeriatria (PDF 19 kb)

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Ferrara, M.C., Andreano, A., Tassistro, E. et al. Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res 32, 1245–1253 (2020). https://doi.org/10.1007/s40520-020-01488-1

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