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

Zwaard, Babette C van der; Stein, Charlotte E.; Bootsma, Janet E. M.; Geffen, H. J. A. A. van; Douw, C. M.; Keijsers, Carolina J. P. W.

doi:10.1007/s00402-019-03294-5

Cited by 25 publications

(26 citation statements)

References 19 publications

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“…Approximately 70% of older patients with hip fractures are graded III to IV in the American Association of Anesthesiologists (ASA) grading system ( 31 ). Babette’s study showed that shared decision-making with geriatricians during the acute assessment of, and communication with, older hip fracture patients in the ED leads to significantly more patients and their representatives choosing non-surgical management and palliative care ( 32 ). Severe dementia and poor prior function were the most common reasons not to have surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

et al. 2022

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BackgroundGeriatric hip fracture is one of the most common end-stage events in older patients with osteoporosis. We aimed to improve the original co-management process by engaging emergency physicians in the preoperative multidisciplinary management team (MDT). We evaluated this intervention in terms of reducing patient waiting time before surgery.MethodsEmergency Department data and hospitalization data for patients diagnosed with geriatric hip fractures in Beijing Jishuitan Hospital (JSTH) were collected and sorted into the intervention group, for whom the MDT included emergency physicians (from January 2019 to December 2019), and the control group (from January 2017 to December 2017). The percentage of patients treated with surgery within 48 h of admission was used as the primary outcome. The secondary outcomes included the time from emergency visit to admission (hours), the time from admission to discharge (days), the percentage of patients receiving surgical treatment after admission, the rate of perioperative medical complications during hospitalization, postoperative admission to the Intensive Care Unit, and total deaths during hospitalization.ResultsA total of 2,152 patients were enrolled. The rate of hypertension (58.5% vs 52.1%), coronary heart disease (24.6% vs 19.9%), and cerebrovascular disease (19.4% vs 15.5%) was higher in the intervention group than in the control group. The percentage of patients receiving surgical treatment in the intervention group (98.3%) was significantly higher than in the control group (96.3%, p = 0.004). The proportion of patients receiving surgical treatment within 48 h of admission was significantly higher in the intervention group (82.4%) than in the control group (60.4%, p < 0.001). The hospital stay was significantly shorter in the intervention group compared with the control group (p < 0.001). The incidence of perioperative medical complications and mortality during hospitalization was similar in the two groups.ConclusionsInvolving emergency physicians in the MDT can reduce the waiting time before surgery and the hospital stay for older hip fracture patients.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

et al. 2022

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“…The decision for surgery or NOM was made as a shared decision-making consultation with the patient and relatives. ACP was applied by mutually exploring treatment preferences, mobility, quality of life, goals in life, and survival in a comprehensive geriatric assessment (van der Zwaard et al 2020 ). Surgery consisted of either hemiarthroplasty or internal fixation.…”

Section: Methodsmentioning

confidence: 99%

“…In particular, frail elderly patients experience a substantial decrease in quality of life and mobility in the 12 months after hip fracture surgery (Amarilla-Donoso et al 2020 ). Deliberations whether to operate or not in these frail elderly patients are common in daily practice (Dunn et al 2016 , van der Zwaard et al 2020 , Rietjens et al 2021 ). Surgery is still the mainstay of treatment because it results in a better mobility and survival (van de Ree et al 2017 , Berry et al 2018 ) and nonoperative management (NOM) is often characterized by problematic after-treatment with substantial patient discomfort.…”

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confidence: 99%

Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

et al. 2021

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“…Patient characteristics were comparable. Reasons not to undergo surgery included aversion to be more dependent on others and severe dementia [136].…”

Section: Prognostic Factors and Mortalitymentioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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

Cited by 25 publications

References 19 publications

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

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