Retrospective Evaluation of the Impact of a Geriatric Trauma Institute on Fragility Hip Fracture Patient Outcomes

Katrancha, Elizabeth D.; Zipf, Jami; Abrahams, Nancy; Schroeder, Richard G.

doi:10.1097/nor.0000000000000380

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…To address these challenges, orthogeriatric care was developed as a model of collaboration between geriatricians, orthopaedic surgeons, and an interprofessional team of nurses, therapists, and others [3]. Orthogeriatric care has been shown to decrease the prevalence of postoperative complications [4–10], readmission rates [4, 5, 9, 11], and mortality [4, 6, 8, 11–16] in hip fracture patients, as compared to traditional orthopaedic care. The majority of these studies were designed as retrospective [6, 7, 9, 10, 12–14, 16] or prospective cohort studies with a historical cohort [4, 5, 11, 15], and only one study as a randomized controlled trial [8].…”

Section: Introductionmentioning

confidence: 99%

The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study

Abrahamsen,

Nørgaard,

Draborg

et al. 2019

BMC Geriatr

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Background While orthogeriatric care to patients with hip fractures is established, the impact of similar intervention in patients with fragility fractures in general is lacking. Therefore, we aimed to assess the impact of an orthogeriatric intervention on postoperative complications and readmissions among patients admitted due to and surgically treated for fragility fractures. Methods A prospective observational cohort study with a retrospective control was designed. A new orthogeriatric unit for acute patients of sixty-five years or older with fragility fractures in terms of hip, vertebral or appendicular fractures was opened on March 1, 2014. Patients were excluded if the fracture was cancer-related or caused by high-energy trauma, if the patient was operated on at another hospital, treated conservatively with no operation, or had been readmitted within the last month due to fracture-related complications. Results We included 591 patients; 170 in the historical cohort and 421 in the orthogeriatric cohort. No significant differences were found between the two cohorts with regard to the proportion of participants experiencing complications (24.5% versus 28.3%, p = 0.36) or readmission within 30 days after discharge (14.1% vs 12.1%, p = 0.5). With both cohorts collapsed and adjusting for age, gender and CCI, the odds of having postoperative complications as a hip fracture patient was 4.45, compared to patients with an appendicular fracture (p < 0.001). Furthermore, patients with complications during admission were at a higher risk of readmission within 30 days than were patients without complications (22.3% vs 9.5%, p < 0.001). Conclusions In older patients admitted with fragility fractures, our model of orthogeriatric care showed no significant differences regarding postoperative complications or readmissions compared to the traditional care. However, we found significantly higher odds of having postoperative complications among patients admitted with a hip fracture compared to other fragility fractures. Additionally, our study reveals an increased risk of being readmitted within 30 days for patients with postoperative complications.

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Section: Introductionmentioning

confidence: 99%

The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study

Abrahamsen,

Nørgaard,

Draborg

et al. 2019

BMC Geriatr

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“…Nursing quality is an essential part of rehabilitation for elderly patients with hip fracture. The incidences of bedsores, pneumonia, deep vein thrombosis (DVT), and hypovolemia can be prevented if the patient can turn over, sit up in bed independently, and initiate requests for food and water [25]. In the FONB group in this study, patients were more likely to turn over and sit up in their beds due to better pain control.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study to Compare Analgesia from Femoral Obturator Nerve Block with Fascia Iliaca Compartment Block for Acute Preoperative Pain in Elderly Patients with Hip Fracture

et al. 2019

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BackgroundThis study aimed to compare femoral obturator nerve block (FONB) with fascia iliaca compartment block (FICB) in the management of acute preoperative pain in elderly patients with hip fracture.Material/MethodsPatients ≥65 years (n=154) diagnosed with hip fracture who had surgery within 48 hours of hospital admission included two groups who received ultrasound-guided nerve block, the FONB group (n=77), and the FICB group (n=77). The visual analog scale (VAS) score for pain, requirement for analgesic drugs, nursing care requirements after hospitalization, post-operative complications, and rehabilitation were compared between the FONB and FICB patient groups.ResultsThe VAS scores after both nerve block procedures were significantly reduced compared with those before both nerve block procedures (P<0.05), but there were no differences on the second day after nerve block. The VAS scores at rest and on exercise in the FONB group were significantly lower than those in the FICB group at 30 min and one day after nerve block (P<0.05). The requirement for postoperative analgesic drugs in the FONB group was significantly lower than that in the FICB group (P=0.048). The incidence of nausea and vertigo in the FICB group were significantly higher than in the FONB group (P=0.031 and P=0.034, respectively). Patients in the FONB group experienced significantly improved quality of postoperative function (P=0.029).ConclusionsBoth FONB and FICB provided pain control for elderly patients with hip fracture. However, compared with FICB, FONB resulted in significantly improved analgesia with a reduced requirement for analgesic drugs.

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“…To address these challenges, orthogeriatric care was developed as a model of collaboration between geriatricians, orthopaedic surgeons, and an interprofessional team of nurses, therapists, and others [3]. Orthogeriatric care has been shown to decrease the prevalence of postoperative complications [4][5][6][7][8][9][10], readmission rates [4,5,9,11], and mortality [4,6,8,[11][12][13][14][15][16] in hip fracture patients, as compared to traditional orthopaedic care. The majority of these studies were designed as retrospective [6,7,9,10,[12][13][14]16] or prospective cohort studies with a historical cohort [4,5,11,15], and only one study as a randomized controlled trial [8].…”

Section: Introductionmentioning

confidence: 99%

The impact of an orthogeriatric intervention in patients with fragility fractures: A cohort study

Abrahamsen

Nørgaard

Draborg

et al. 2019

Preprint

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Background: While orthogeriatric care to patients with hip fractures is established, the impact of similar intervention in patients with fragility fractures in general is lacking. Therefore, we aimed to assess the impact of an orthogeriatric intervention on postoperative complications and readmissions among patients admitted due to and surgically treated for fragility fractures. Methods: A prospective observational cohort study with a retrospective control was designed. A new orthogeriatric unit for acute patients of sixty-five years or older with fragility fractures in terms of hip, vertebral or appendicular fractures was opened on March 1, 2014. Patients were excluded if the fracture was cancer-related or caused by high-energy trauma, if the patient was operated on at another hospital, treated conservatively with no operation, or had been readmitted within the last month due to fracture-related complications. Results: We included 591 patients; 170 in the historical cohort and 421 in the orthogeriatric cohort. No significant differences were found between the two cohorts with regard to the proportion of participants experiencing complications (24.5% versus 28.3%, p = 0.36) or readmission within 30 days after discharge (14.1% vs 12.1%, p = 0.5). With both cohorts collapsed and adjusting for age, gender and CCI, the odds of having postoperative complications as a hip fracture patient was 4.45, compared to patients with an appendicular fracture (p < 0.001). Furthermore, patients with complications during admission were at a higher risk of readmission within 30 days than were patients without complications (22.3% vs 9.5%; p < 0.001). Conclusions: In older patients admitted with fragility fractures, our model of orthogeriatric care showed no significant differences regarding postoperative complications or readmissions compared to the traditional care. However, we found significantly higher odds of having postoperative complications among patients admitted with a hip fracture compared to other fragility fractures. Additionally, our study reveals an increased risk of being readmitted within 30 days for patients with postoperative complications.

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Retrospective Evaluation of the Impact of a Geriatric Trauma Institute on Fragility Hip Fracture Patient Outcomes

Abstract: This retrospective pre- and post-GTI chart review demonstrates the effectiveness of a multidisciplinary team approach in decreasing complications and LOS for fragility hip-fractured patients. A team approach to the care of these patients improves outcomes and quality of life.

Cited by 16 publications

References 8 publications

The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study

The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study

A Prospective Study to Compare Analgesia from Femoral Obturator Nerve Block with Fascia Iliaca Compartment Block for Acute Preoperative Pain in Elderly Patients with Hip Fracture

The impact of an orthogeriatric intervention in patients with fragility fractures: A cohort study

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