Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Abstract

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

Application of integrated management bundle incorporating with multidisciplinary measures improved in-hospital outcomes and early survival in geriatric hip fracture patients with perioperative heart failure: a retrospective cohort study

“…Liu and Rosas et al [25] presented clinical evidence demonstrating that enhanced recovery after surgery (ERAS) was associated with significant decreases in hospital length of stay and postoperative complication and it is effective in improving outcomes in surgical populations. That is to say, optimization of original perioperative management mode could improve outcomes of patients [20,[44][45][46]. Further studies should be carried out in order to better clarify the effect.…”

Primär endoprothetische Versorgung von Kniegelenksfrakturen

“…Die Versorgung geriatrischer Patienten stellt besondere Anforderungen an den behandelnden Arzt und erfordert oft individuelle Therapiekonzepte: Zum einen stellt die Fraktur i. d. R. kein isoliert zu betrachtendes Ereignis dar, sondern ist vielmehr der Ausdruck einer zugrunde liegenden Gebrechlichkeit (Frailty) und Multimorbidität, die genauso therapiert werden müssen wie der Bruch selbst. Hier hat sich mittlerweile ein orthogeriatrisches Comanagement etabliert und konnte überlegene Behandlungsergebnisse zeigen [5,6,7,8,9]. In der Frakturbehandlung selbst ist zu beachten, dass eine Teilbelastung vom geriatrischen Patienten nicht umgesetzt werden kann [10] und somit eine vollbelastungsstabile Versorgung erforderlich ist.…”

“…Perigenicular fractures in elderly patients tend not to be an isolated event, but a manifestation of underlying frailty and comorbidities that need to be treated as much as the fracture itself. Orthogeriatric co-management has established itself as an effective approach in this regard and has demonstrated superior treatment results [5,6,7,8,9]. In terms of the fracture treatment itself, it should be noted that elderly patients are unable to cope with restricted weight-bearing [10] and therefore require a stable full weightbearing treatment option.…”

New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore

“…Heretofore, postoperative infection has not been clearly implicated in early cut-out, but it is especially difficult to confirm really depth ones [ 26 ]. Moreover, there is a clear tendency to immediately allow patients to perform partial weight bearing (PWB) postoperatively, but there are many protocols, and not all patients collaborate, so the role this factor plays is undefined [ 27 ].…”