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The implementation of a Geriatric Fracture Centre for hip fractures to reduce mortality and morbidity: an observational study

  • Trauma Surgery
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Abstract

Introduction

The aim of this study was to evaluate the effect of an orthogeriatric treatment model on elderly patients with traumatic hip fractures (THF). The Geriatric Fracture Centre (GFC) is a multidisciplinary care pathway with attention for possible age-related diseases, discharge management and out-of-hospital treatment.

Materials and methods

A prospective cohort study with a historical cohort group was conducted at a level I trauma centre in Switzerland. Patients over the age of 70 years with THFs who underwent surgical treatment at GFC in 2013 and 2016 were included. Primary outcomes were mortality and complications. Secondary outcomes were hospital length of stay (HLOS), time to surgery and place of discharge.

Results

A total of 322 patients were included in this study. In 2016, mortality showed a reduction of 2.9% at 30 days (p = 0.42) and 3.4% at 90 days (p = 0.42) and 0.1% at 1 year (p = 0.98). The number of patients with a complicated course showed a decrease of 2.2% in 2016 (p = 0.69). A significant increase in the diagnosis of delirium by 11.2% was seen in 2016 (p < 0.001). The median HLOS was significantly reduced by 2 days (p < 0.001). An increase of 21.1% was seen in patients who were sent to rehabilitation in 2016 (p < 0.001). Day-time surgery increased by 10.2% (p = 0.04).

Conclusion

The implementation of the GFC leads to improved processes and outcomes for geriatric patients with THFs. Increased awareness and recognition led to an increase in the diagnosis of complications that would otherwise remain untreated. Expanding these efforts might lead to more significant effects and an increase in the reduction of morbidity and mortality in the future.

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Author notes

  1. J. Q. Kusen and B. Schafroth shared the first authorship.

Authors and Affiliations

  1. Klinik Orthopädie Und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland

    J. Q. Kusen, P. C. R. van der Vet, B. C. Link, R. H. Babst & F. J. P. Beeres

  2. Klinik für Anästhesie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland

    B. Schafroth & B. Poblete

  3. Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands

    F. J. G. Wijdicks

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J. Q. Kusen, B. Schafroth, B. Poblete, P. C. R. van der Vet, B.C. Link, F. J. G. Wijdicks, R. H. Babst and F. J. P. Beeres declare that they have no conflict of interest.

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Kusen, J.Q., Schafroth, B., Poblete, B. et al. The implementation of a Geriatric Fracture Centre for hip fractures to reduce mortality and morbidity: an observational study. Arch Orthop Trauma Surg 139, 1705–1712 (2019). https://doi.org/10.1007/s00402-019-03229-0

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