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Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture

  • Trauma Surgery
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A Correction to this article was published on 30 November 2019

This article has been updated

Abstract

Introduction

Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death.

Materials and methods

A single-center, with a level 2 trauma center, retrospective study comparing care before and after introducing pre-operative CGA with shared decision making in September 2014. Patients ≥ 70 years with a hip fracture, admitted from January 2014 to September 2015, were included. The percentages of patients elected for non-surgical management and palliative care without or with CGA were compared. Differences in secondary objectives (age, sex, medical history, medication use, functional, and social status) were compared descriptively and qualitatively.

Results

With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008). Patient characteristics were comparable. Reported reasons not to undergo surgery include aversion to be more dependent on others, and severe dementia.

Conclusion

The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room.

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Change history

  • 30 November 2019

    The original version of this article unfortunately contained a mistake. The presentation of Figure 1 was incorrect. The correct version of Figure 1 is given in the following page.

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Funding

This study was not sponsored.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, ‘s-Hertogenbosch, The Netherlands

    Babette C. van der Zwaard & Conny M. Douw

  2. Department of Geriatric Medicine, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

    Charlotte E. Stein, Janet E. M. Bootsma & Carolina J. P. W. Keijsers

  3. Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

    Hendrikus J. A. A. van Geffen

Authors
  1. Babette C. van der Zwaard
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  2. Charlotte E. Stein
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  3. Janet E. M. Bootsma
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  4. Hendrikus J. A. A. van Geffen
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  5. Conny M. Douw
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  6. Carolina J. P. W. Keijsers
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Correspondence to Babette C. van der Zwaard.

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van der Zwaard, B.C., Stein, C.E., Bootsma, J.E.M. et al. Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture. Arch Orthop Trauma Surg 140, 487–492 (2020). https://doi.org/10.1007/s00402-019-03294-5

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  • DOI: https://doi.org/10.1007/s00402-019-03294-5

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