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Association of orthogeriatric services with long-term mortality in patients with hip fracture

Abstract

Purpose

To assess the impact of the comprehensive orthogeriatric care model (OGM) on 2-year survival, length of stay (LOS), discharges to nursing homes, and antiosteoporotic treatment (AOT) in patients with hip fracture.

Methods

Retrospective cohort study. Hospitals were classified as OGM if the patient was cared for in a comprehensive orthogeriatric unit. We included data from patients ≥ 65 years old discharged between 2012 and 2013. The main outcome was 12- and 24-month mortality. The variables collected were sex, type of fracture, comorbidities, AOT, LOS, and discharge to nursing homes. Survival analysis was performed with Kaplan–Meier method and comparison with Mantel–Haenszel test. Factors associated with death were determined by logistic regression.

Results

First admissions in the 12 (out of 32) hospitals with OGM were 3580 of 9215 (38.8%). Patients in OGM had more comorbidities and discharges to nursing homes, shorter LOS, and less prescription of AOT. Two years after the admission the deceased patients were 3000 (32.6%). The survival was lower in males (p < 0.001), in the older age groups (p < 0.001), and in patients with Charlson > 1 (p < 0.001). Factors associated with increased risk of death at 12 and 24 months (logistic regression) were male gender, age and Charlson > 1, while care in the OGM decreased the risk. OGM benefited more patients > 80 years and those with Charlson < 1.

Conclusions

Patients admitted in OGM have shorter stays, more discharges to nursing homes, lower prescription of AOT, and better 12- and 24-month survival adjusted by sex, age, and comorbidities compared to non-OGM care.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

Authors

Contributions

MJP, ML, XS, PSF, and IB have made substantial contributions to the design, acquisition of data, analysis and interpretation of results. MJP has drafted the manuscript. ML, XS, PSF, IB, EFC, and VO have revised the article critically for important intellectual content. All the authors have revised the final version of the manuscript.

Corresponding author

Correspondence to Maria-Jesús Pueyo-Sánchez.

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Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Department of Health of Catalonia and with the 1964 Helsinki declaration and its later amendements or comparable ethical standards.

Informed consent

All the data were anonymised and used in an aggregated manner. So the informed consent was unnecessary.

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Pueyo-Sánchez, MJ., Larrosa, M., Surís, X. et al. Association of orthogeriatric services with long-term mortality in patients with hip fracture. Eur Geriatr Med 9, 175–181 (2018). https://doi.org/10.1007/s41999-018-0028-4

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  • DOI: https://doi.org/10.1007/s41999-018-0028-4

Keywords

  • Hip fracture
  • Survival analysis
  • Orthogeriatrics
  • Antiosteoporotic treatment