Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study

Blauth, M.; Joeris, Alexander; Rometsch, Elke; Espinoza-Rebmann, Kathrin; Wattanapanom, Pannida; Jarayabhand, Rahat; Poeze, Martijn; Wong, Manzhi; Kwek, Ernest Beng Kee; Hegeman, J.H.; Guerado, E.; Revak, Thomas J; Zohner, Sebastian; Joseph, David B.; Gosch, Markus

doi:10.1136/bmjopen-2020-039960

Cited by 8 publications

(16 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While often underdiagnosed in the absence of proactive monitoring [48], delirium is associated with long-term cognitive decline and increased mortality in both surgical and nonsurgical patients [49,50]. Our higher detection rate of delirium after the implementation of OGCM is in line with previous studies [39,51,52]. Therefore, as early detection of delirium is crucial [53], we interpret these findings as being favourable to GTC because the improved detection of UTIs and delirium in turn facilitates improved treatment.…”

supporting

confidence: 85%

“…Therefore, the shorter LOS in the post-GTC group may, rather, be interpreted as being due to earlier mobilisation and transferability to institutes with highly specialised geriatric rehabilitative treatment options. Nonetheless, according to previous studies, the interdisciplinary collaboration in GTCs itself seems also to be associated with reduced LOS, preventing complications, and enabling more patients to return home safely [7,38,39].…”

mentioning

confidence: 85%

See 1 more Smart Citation

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU®). Materials and Methods: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). Results: Patients in the post-GTC group (n = 111) were older (median age 82.0 years) compared to the pre-GTC group (n = 108, median age 80.0 years, p = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all p > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, p = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, p = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, p = 0.094), while an ACDiT score of ≥1 was comparable between groups (p = 0.169). Conclusions: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.

show abstract

supporting

confidence: 85%

mentioning

confidence: 85%

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

et al. 2021

View full text Add to dashboard Cite

show abstract

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS and 20 programs did not. Delayed TTS cutoffs were most often defined dichotomously as more than 24 hours, more than 36 hours, more than 48 hours, or more than 72 hours, although some studies collected continuous data.…”

Section: Resultsmentioning

confidence: 90%

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS 33,35,38,41,[43][44][45][46][47][48][49][51][52][53][54]56,57,[59][60][61][62][65][66][67][68][69][70][71][72][74][75][76][79][80][81][82][85][86][87][88]91,94,96,97,99,101,103 and 20 programs 39,40,42,50,…”

Section: Included Studiesmentioning

confidence: 99%

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

show abstract

“…3). Insgesamt wurden die Daten von 7807 Personen einbezogen, wobei die Mehrzahl der Studien in europäischen Ländern (n = 10) [10,11,20,21,22,23,24,25,26,27] durchgeführt wurde, weitere 2 in asiatischen Ländern [28,29].…”

Section: Studiencharakteristikaunclassified

Langzeitergebnisse des orthogeriatrischen Co-Managements: eine Literaturübersicht

Eiter,

Kellerer

2023

Z Orthop Unfall

View full text Add to dashboard Cite

ZusammenfassungFragilitätsfrakturen der Hüfte sind einer der größten Auslöser für schlechte Gesundheitsergebnisse von älteren Personen. Sie führen häufig zu Einschränkungen der Selbstversorgungsfähigkeit, und die Mortalität ist weiterhin hoch. Das orthogeriatrische Co-Management kann die Resultate dieser Hochrisikopopulation möglicherweise verbessern. Der Einfluss auf Langzeitergebnisse ist jedoch noch nicht abschließend geklärt. Ziel war es, den Einfluss des orthogeriatrischen Co-Managements auf die Mortalitätsrate und die Selbstversorgungsfähigkeit, gemessen am Barthel-Index, 1 Jahr nach einer Hüftfraktur bei Personen ≥ 60 Jahre darzustellen.Eine systematische Literaturrecherche wurde entsprechend den Prozessschritten Identifikation, Selektion und Bewertung durchgeführt, wobei die Datenbanken MEDLINE, CINAHL Complete und Cochrane Library im Zeitraum von Februar bis März 2022 systematisch durchsucht wurden. Eingeschlossen wurden englisch- und deutschsprachige Artikel, die im Zeitraum von 2012 bis 2022 publiziert wurden. Letztlich konnten 12 Studien inkludiert werden.In 6 Studien wurde eine statistisch signifikante Reduzierung der 1-Jahres-Mortalitätsrate aufgezeigt. In nur 1 von 4 Studien, welche die Selbstversorgungsfähigkeit evaluierten, konnte auf einer spezialisierten Abteilung eine signifikante Verbesserung festgehalten werden.Das orthogeriatrische Co-Management scheint dazu beizutragen, die 1-Jahres-Mortalität und die Selbstversorgungsfähigkeit positiv zu beeinflussen. Die Implementierung dieser Versorgungsform ist angesichts der heterogenen Studienresultate allerdings nur eingeschränkt zu empfehlen.

show abstract

Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study

Cited by 8 publications

References 54 publications

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Langzeitergebnisse des orthogeriatrischen Co-Managements: eine Literaturübersicht

Contact Info

Product

Resources

About