Comparison of Complications and Length of Hospital Stay Between Orthopedic and Orthogeriatric Treatment in Elderly Patients With a Hip Fracture

Abstract

Hip fractures in the elderly individuals are a complex problem. Our objective was to determine whether orthogeriatric treatment is effective in terms of reducing length of hospital stay, morbidity, and mortality of elderly patients with a hip fracture compared with orthopedic (traditional) treatment. From July 2009 to May 2011, patients older than 65 years with a hip fracture were followed prospectively. They were co-treated by geriatric and orthopedic teams. This cohort was compared with a retrospective cohort followed from January 2007 to June 2009 that was managed by the orthopedic surgery team only. Epidemiology, pre- and postoperative hematocrit, and renal function were registered. Also, in-hospital and distant mortality data (determined by consulting the national registry), mortality-associated factors, postoperative complications, hospital stay length, and transfers to other services were registered. One hundred and eighty-three patients in the retrospective group and 92 in the prospective group were included in this study with a median follow-up of 26 months (interquartile range: 13-41). The average age was 84 years and 74% of patients were female. Intertrochanteric fracture accounted for 51% of the cases. There was no difference between groups with regard to hospital stay length, hematocrit at discharge, in-hospital mortality, long-term survival, or transfers to internal medicine or the intensive care unit. It did show differences in the transfer to the intermediate care unit, prolonged hospitalizations (>20 days), and diagnosis of delirium and anemia requiring transfusion. In the present study, orthogeriatric treatment is slightly more effective than traditional treatment in terms of morbidity, but there is no difference in hospital stay length or mortality. Further studies and longer follow-up are needed to draw more conclusions.

Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up

“…In many studies, mortality after hip fractures has been reported as 20–30%. [3,6,7,12] .This high mortality rate is due not only to trauma or major surgery but also to co-existingcardiac, pulmonary or renal diseases, old age and preoperative cognitive dysfunction [3–5, 12–15]. Elderly patients are particularly prone to mortality in the first year after a hip fracture with mortality rate ranging from 14% to 36% [1,6,7] .…”

“…Wagner reported that 25% of patients with a hip fracture become dependent on nursing, 50% recover to preoperative status and the remaining 25% die, usually within the first year postoperatively [6]. Male gender, increasing age, cognitive function impairment and high ASA scores have been found to be significantly associated with mortality in these patients [7] .…”

Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database

“…In 2007, approximately 150,000 adults were hospitalized for hip fracture in Japan, and this number is expected to increase with the aging of the population [2]. Elderly patients often have multiple comorbidities before hip fracture, and are considered to be at a high risk of postoperative complications [3].…”

Complicaciones presentadas en pacientes mayores de 65 años ingresados por fractura de cadera en un hospital andaluz de tercer nivel

“…La estancia media de 10,2 días está cercana a las medias más bajas encontradas en la literatura revisada (21)(22)(23)25,26) , aunque no es fácil la comparación con otros teniendo en cuenta que en algunos casos se incluye en la estancia media los primeros días de rehabilitación.…”

“…El diagnóstico más frecuente, fractura de sección trocanterea neom de cuello de fémur cerrada, es una fractura extracapsular, lo que está en consonancia con lo revisado (2,19,(21)(22)(23)(24) . La estancia media preoperatoria, de 3,5 días, es acorde con la mediana en España que se sitúa alrededor de los 3 días.…”