Orthogeriatric Trauma Unit Improves Patient Outcomes in Geriatric Hip Fracture Patients

Abstract

Introduction: An aging population in developed countries has increased the number of osteoporotic hip fractures and will continue to grow over the next decades. Previous studies have investigated the effect of integrated orthogeriatric trauma units and care model on outcomes of hip fracture patients. Although all of the models perform better than usual care, there is no conclusive evidence which care model is superior. More confirmative studies reporting the efficacy of orthogeriatric trauma units are needed. The objective of this study was to evaluate outcomes of hip fracture patients admitted to the hospital before and after implementation of an orthogeriatric trauma unit. Materials and methods: This retrospective cohort study was conducted at a level 2 trauma center between 2016 and 2018. Patients aged 70 years or older with a hip fracture undergoing surgery were included to evaluate the implementation of an orthogeriatric trauma unit. The main outcomes were postoperative complications, patient mortality, time spent at the emergency department, time to surgery, and hospital length of stay. Results: A total of 806 patients were included. After implementation of the orthogeriatric trauma unit, there was a significant decrease in postoperative complications (42% vs. 49% in the historical cohort, p = 0.034), and turnaround time at the emergency department was reduced by 38 minutes. Additionally, there was significantly less missing data after implementation of the orthogeriatric trauma unit. After correcting for covariates, patients in the orthogeriatric trauma unit cohort had a lower chance of complications (OR 0.654, 95% CI 0.471-0.908, p = 0.011) and a lower chance of 1-year mortality (OR 0.656, 95% CI 0.450-0.957, p = 0.029). Conclusions: This study showed that implementation of an orthogeriatric trauma unit leads to a decrease in postoperative complications, 1-year mortality, and time spent at the emergency department, while also improving the quality of data registration for clinical studies. Level of Evidence: Level III.

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.…”

Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs

“…5 Because older surgical patients have specific vulnerabilities and co-existing medical conditions that require special attention, geriatrics expertise, and dedicated time in co-management models improve postsurgical outcomes. 6,[15][16][17] [Correction added on 9 February 2023, after first online publication: The first sentence in this paragraph has been modified.] For example, after changing the culture from a crisis-driven to a proactive prevention model for the care of older surgical patients through a co-management model, we experienced numerous positive results, including healthcare cost savings.…”

“…13,14 For example, a geriatric comanagement model in orthopedics for hip fracture patients reduces postoperative complications, length of stay (LOS), and hospital costs compared to patients receiving usual surgical care. [15][16][17] In addition, the Perioperative Optimization of Senior Health (POSH) program reduces complications, LOS, and readmissions in elective colorectal surgery patients compared to age-matched patients who received standard care. 6 The Optimization of Senior Care and Recovery (OSCAR) program is an integrated care model that combines geriatrics co-management with postoperative surgical care.…”

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

“…El modelo ortogeriátrico reduce en 38 minutos la estancia en el servicio de emergencia y reduce la mortalidad a un año posterior a la cirugía (Schuijt et al, 2020). También, coordina la resolución quirúrgica en las primeras 24-48 horas después del ingreso, una valoración geriátrica integral, elaboración de un plan de rehabilitación individual, el apoyo brindado por el terapeuta ocupacional, una planificación del alta, seguimiento por atención primaria de salud, con opción de rehabilitación física y atención domiciliaria (Pioli, Bendini, Pignedoli, Giusti, & Marsh, 2018) .…”