Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

Abstract

Background: Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. Thus, an interdisciplinary orthogeriatric treatment of these patients has recognized a growing acceptance in the last years. As there is still limited data on the impact of this approach, the present study aimed to evaluate the long-term outcome in elderly hip fracture patients, by comparing the treatment of a hospital with integrated orthogeriatric care (OGC) with a conventional trauma care (CTC). Methods: We conducted a retrospective, two-center, cohort study. In two maximum care hospitals all patients presenting with a hip fracture at the age of ≥ 70 years were consecutively assigned within a 1 year period and underwent follow-up examination 12 months after surgery. Patients treated in hospital site A were treated with an interdisciplinary orthogeriatric approach (co-managed care), patients treated in hospital B underwent conventional trauma care. Main outcome parameters were 1 year mortality, readmission rate, requirement of care (RC) and personal activities of daily living (ADL). Results: A total of 436 patients were included (219 with OGC / 217 with CTC). The mean age was 83.55 (66-99) years for OGC and 83.50 (70-103) years for CTC (76.7 and 75.6% of the patients respectively were female). One year mortality rates were 22.8% (OGC) and 28.1% (CTC; p = 0.029), readmission rates were 25.7% for OGC compared to 39.7% for CTC (p = 0.014). Inconsistent data were found for activities of daily living. After 1 year, 7.8% (OGC) and 13.8% (CTC) of the patients were lost to follow-up. Conclusions: Interdisciplinary orthogeriatric management revealed encouraging impact on the long-term outcome of hip fracture patients in the aging population. The observed reduction of mortality, requirements of care and readmission rates to hospital clearly support the health-economic impact of an interdisciplinary orthogeriatric care on specialized wards. Trial registration: The study was approved and registered by the bavarian medical council (BLAEK: 7/11192) and the local ethics committee of munich university (Reg. No. 234-16) and was conducted as a two-center, cohort study at a hospital with integrated orthogeriatric care and a hospital with conventional trauma care.

Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis

“…1, all studies but one [29] reported data on LOS, while data on in-hospital mortality were reported in 23 studies [16, 20, 22-25, 27, 31-33, 35-38, 43-46, 48-52]. In contrast, only about half of the studies reported data on TTS [21-25, 30, 32-35, 38, 39, 42-47, 51], complication rates [17, 20, 22, 25, 28, 32, 33, 35-39, 41, 43-45, 47, 51], and 1-year mortality [18,27,31,32,35,38,39,41,42,44,[47][48][49][50]. 30-day readmission rate [18,33,35,37,41,45], functional outcomes [18, 21-23, 27, 34], and cost [21,26,29,31,40] were reported in less than a quarter of the studies.…”

“…Of the 37 included studies, only ten studies were RCTs [16][17][18][19][20][21][22][23][24][25]. Six studies were prospective cohort studies [26][27][28][29][30][31], ten were prospective cohort studies with a retrospective control [32][33][34][35][36][37][38][39][40][41], ten were retrospective cohort studies [42][43][44][45][46][47][48][49][50][51], and one study was a prospective pre-and post-intervention study [52]. Results of the Cochrane collaboration's tool for assessing risk of bias are given in Table 2.…”

“…Data on LOS were available in 36 studies. Ten of these could not be included in the metaanalysis as the reported data did not correspond to the data required for the meta-analysis [17,22,25,30,33,37,38,41,42,48]. In addition, two studies were not included in the meta-analysis, as more recent data of the same cohorts were available and reported in the meta-analyses [21,27].…”

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

“…This could be interpreted as orthogeriatric treatment especially preventing early readmissions while having a lesser impact with longer follow-up. According to one previous study, orthogeriatric treatment has been associated with decreased mortality and a lower readmission rate [33] whereas such association has not been reported in other studies [2], including a randomized controlled trial [14]. In all these studies, the orthogeriatric intervention has lasted longer than in our study (i.e., for 1.5-2 weeks), and we are not aware of earlier studies concerning the effect of very short orthogeriatric intervention, like ours, on readmission rates, mortality or clinical outcomes.…”

A Meta-Analysis of Acute Kidney Injury in Patients Undergoing Hip Fracture Surgery: Prevalence and Risk Factors

“…The worldwide population is continuously aging, thereby leading to an increase in the prevalence of osteoporotic hip fractures. 1,2 A recent statistical estimation predicts that the patients receiving surgical interventions for hip fracture will double by 2050 owing to the aging of population. 3 Furthermore, hip fracture is a major public health challenge, for it causes serious morbidity, death, and socioeconomic burden.…”