Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?

Abstract

Background Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated. Methods This retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone. Results Baseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573). Conclusion We found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.

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

“…As indicated in Table 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 – 50 ]. 30-day readmission rate [ 18 , 33 , 35 , 37 , 41 , 45 ], functional outcomes [ 18 , 21 – 23 , 27 , 34 ], and cost [ 21 , 26 , 29 , 31 ,…”

“…Complications in hip fracture patients were evaluated in 18 trials (Table 4 ) [ 17 , 20 , 22 , 25 , 28 , 32 , 33 , 35 – 39 , 41 , 43 – 45 , 47 , 51 ]. The data were very heterogeneous, with the evaluated complications varying largely, from total complications over different medical or surgical complications to delirium only.…”

“…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.…”

“…The effect of orthogeriatric care on TTS was examined in a meta-analysis. Out of the 19 studies that had data on TTS, 13 were included in the meta-analysis [21,23,25,32,34,35,39,[43][44][45][46][47]51] (Fig. 3), while six were not because the data did not fulfill the requirements for the meta-analysis [22,24,30,33,38,42].…”

Importancia de la atención ortogeriátrica en pacientes con fractura de cadera. A propósito de un caso.

“…El abordaje fisioterapéutico en ortogeriatría debe ser inmediato al post-operatorio (mismo día de la intervención), centrado en las movilizaciones adecuadas, tratamiento del dolor, cambios posturales, énfasis en sedestación e inicio precoz de la marcha con ayudas técnicas (andador o muletas), así como la formación al paciente y a la familia son de vital importancia para que el usuario sea dado de alta previo a una valoración fisiátrica y continuar con el seguimiento ambulatorio (Werner et al, 2020;Yeap, Hew, & Chan, 2017).…”