AltersTraumaZentrum DGU®: Evaluation klinischer und ökonomischer Parameter

Knobe, Matthias; Böttcher, Bettina; Coburn, Mark; Friess, Thomas; Bollheimer, Leo Cornelius; Heppner, Hans Jürgen; Werner, Cornelius J.; Bach, Jan-Philipp; Wollgarten, M.; Poßelt, S.; Bliemel, Christopher; Bücking, Benjamin

doi:10.1007/s00113-018-0502-y

Cited by 27 publications

(21 citation statements)

References 41 publications

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“…For Germany, there are only a few studies investigating OGCM yet, of which one did not only focus on hip fractures but included further geriatric fractures [ 29 ]. Based on a rather small sample, it found statistically insignificant results regarding mortality, ability to walk, complications, as well as costs favouring OGCM.…”

Section: Introductionmentioning

confidence: 99%

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data

Schulz

Büchele²,

Peter³

et al. 2021

Eur J Health Econ

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Background Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. Methods This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves. Results 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective. Conclusion Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.

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Section: Introductionmentioning

confidence: 99%

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data

Schulz

Büchele²,

Peter³

et al. 2021

Eur J Health Econ

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“…During the study period, there was no integrated orthogeriatric care unit in St. Antonius hospital. Orthogeriatric care units have been shown to improve patient outcomes [27,28]. By identifying patients at risk for negative medical outcomes, geriatric interventions can be targeted at those patients that would benefit from them.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Schuijt

Bos

Smeeing

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Orthogeriatric trauma patients are at risk for functional decline and mortality. It is important to identify high-risk patients in an early stage, to improve outcomes and make better informed treatment decisions. The aim of this study was to identify independent risk factors for 30-day mortality in patients aged 85 years or above admitted from the emergency department with a fracture. Methods All orthopaedic trauma patients 85 years or above admitted from the emergency department were included. After a 30-day follow-up, mortality was determined by consulting the patient records. Multivariable logistics regression analysis generated odd ratios for mortality risk factors. A subgroup analysis was performed for patients undergoing hip fracture surgery. Results The 30-day mortality in geriatric fracture patients admitted to the hospital was 12%. Risk factors for 30-day mortality were: increased age, male sex, decreased hemoglobin levels, living in an institutional care facility and a decreased BMI. For geriatric patients undergoing hip fracture surgery 30-day mortality was 11%. Independent risk factors for this group were: increased age, male sex, and a decreased BMI. Conclusion Orthopaedic trauma patients aged 85 years or above who are admitted to the hospital with a fracture are at high risk for mortality. This study identified older age, male sex, and decreased BMI as predictors of 30-day mortality in admitted geriatric fracture patients and in geriatric hip fracture patients undergoing surgery.

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“…Our study only focused on geriatric trauma patients, whereas age was not an exclusion criterion in the other studies [ 20 ]. Additionally, all of our patients were treated in an orthogeriatric setting [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications

Knauf

Eschbach

Buecking³

et al. 2021

Medicina

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Background and Objectives: Hip fractures are among the most typical geriatric fractures. Subtrochanteric fractures are considered difficult to treat, and, to date, there is no consensus on the optimal surgical treatment. Materialis and Methods: We analyzed data from the Registry for Geriatric Trauma, which includes patients ≥ 70 years old with hip fractures or periprosthetic fractures requiring surgery (21,734 patients in 2017–2019). For this study, we analyzed only the subgroup of patients with a subtrochanteric fracture. We analyzed the difference between closed and open surgical methods on a range of outcomes, including mortality, mobility, length of acute hospital stay, and the need for surgical revisions. Results: A total of 506 patients with subtrochanteric fractures were analyzed in this study. The median age was 85 years (interquartile range of 81–89). About 21.1% (n = 107) were operated on with a closed technique, 73.3% (n = 371) with open reduction without using a cerclage, and 5.53% (n = 28) with open reduction with the additional use of one or more cerclage wires. A total of 3.56% (n = 18) of the patients had complications requiring operative revision, most commonly soft tissue interventions (open vs. closed reduction—3.26% vs. 4.67%) (p = 0.687). Patients treated with open reduction were significantly more mobile 7 days after surgery (p = 0.008), while no significant effects on mortality (p = 0.312), length of hospital stay (p = 0.968), or surgical complications (p = 0.687) were found. Conclusion: Proper reduction is the gold standard practice for successful union in subtrochanteric fractures. This study shows that open reduction is not associated with a higher complication rate but does lead to increased mobility 7 days after operation. Therefore, in case of doubt, a good reduction should be aimed for, even using open techniques.

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AltersTraumaZentrum DGU®: Evaluation klinischer und ökonomischer Parameter

Cited by 27 publications

References 41 publications

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data

Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Open Reduction in Subtrochanteric Femur Fractures Is Not Accompanied by a Higher Rate of Complications

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