Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures

Abstract

Introduction Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture? Methods and materials Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit. Results Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant. Discussion Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

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

“…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.…”

“…190 studies underwent full-text review, and 69 studies were selected for final analysis ( Figure and eAppendix 3 in the Supplement ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”

Implementation of Orthogeriatrics in Portugal

“…The Orthogeriatrics Unit of the Vila Nova de Gaia Hospital Centre (CHVNGE) was the first of its kind created in Portugal, with a multidisciplinary team with co-management between internal medicine and orthopaedics [13,14]. The orthogeriatric unit objectives were to decrease in-hospital mortality as well as post-discharge medium and long-term survival and quality of life improvement, through several ways: early treatment of medical complications; prevention and treatment of geriatric syndromes such as frailty, functional limitation, falls, depression, polypharmacy, malnutrition, and cognitive impairment; reduction of pre-surgical waiting; recovery of the previous functional status in the shortest time and at the lowest possible cost; offering higher quality clinical care through daily clinical evaluation, managing complications, pre and post-surgical optimization; functional rehabilitation consultation; nutritional assessment; social assessment; and secondary prevention of bone fractures at discharge [9,[15][16][17][18][19][20][21][22].…”

Preoperative Prevalence and Risk Factors For Calf Muscular Vein Thrombosis in Elderly Patients with Hip Fracture

“…Delayed surgery in patients with acute hip trauma is one of the key factors leading to a high incidence of preoperative DVT. 6 CMVT is commonly considered the starting site for thrombosis of the lower extremities. There is no recommendation of a unified standard for the treatment of CMVT in the latest American College of Chest Physicians guidelines.…”