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

Abstract

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.

Evaluation of costs, osteoporosis treatment, and re-fractures in German collaborative orthogeriatric care after fragility fractures

“…As collaborative orthogeriatric care was initially intended for hip fractures, most studies focused on these fractures and found beneficial effects compared to usual care regarding in-hospital [ 10 , 13 , 14 ], 30-day [ 15 – 21 ], and 1-year mortality [ 10 , 14 , 18 , 22 – 24 ], regain of functional status and walking ability [ 13 , 24 , 25 ], and more quality-adjusted life years [ 22 , 26 ]. Studies focusing on pelvic and spine fractures found benefits compared to usual care in terms of more identified complications [ 27 , 28 ] and fewer revision surgeries necessary [ 28 ]. However, evidence on mortality for fracture sites other than hip or outcomes for humerus and forearm fractures is less conclusive or lacking at all [ 27 – 30 ].…”

“…Studies focusing on pelvic and spine fractures found benefits compared to usual care in terms of more identified complications [ 27 , 28 ] and fewer revision surgeries necessary [ 28 ]. However, evidence on mortality for fracture sites other than hip or outcomes for humerus and forearm fractures is less conclusive or lacking at all [ 27 – 30 ]. Overall, collaborative orthogeriatric care might be beneficial for the treatment of non-hip fragility fractures as well, but as to date, comprehensive evidence is scarce.…”