The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

Abstract

In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24-48 h after arrival at the hospital, while the length of hospital stay shortened. Introduction Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation. Methods Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods. Results A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years. Conclusions The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24-48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population.

Health care services and costs after hip fracture, comparing conventional versus standardised care: A retrospective study with 12-month follow-up

“…A standardised care often uses principles from lean methodology [5] to improve patient outcomes and hospital efficiency, leading to decreased hospital length of stay (LOS) [6] . A standardised care for patients with a hip fracture at our hospital led to a reduction of 3.4 days in LOS, with no increase in mortality or readmission [7] , consistent with other studies [8][9][10][11] . A reduction in LOS may counter the increased demand for hospital care and expanding costs [12] .…”

The Effect of Pre-Operative Medical Co-Morbidities on Rehabilitation Outcomes Following Surgery for Hip Fracture Management in Geriatric Populations

“…Studies have shown that at the 6 month mark following surgery for hip fractures only 50% of the patients were able to regain independence with activities of daily living(ADL). 2,3 The 1-year mortality for hip fractures ranges from 8.4% to 36%. This imposes a heavy burden on the health care system as well as the community.…”

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 ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”