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

Abrahamsen, Charlotte; Nørgaard, Birgitte; Draborg, Eva; Nielsen, Morten Frost

doi:10.1186/s12877-019-1299-4

Cited by 17 publications

(22 citation statements)

References 37 publications

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“…This could be interpreted as orthogeriatric treatment especially preventing early readmissions while having a lesser impact with longer follow-up. According to one previous study, orthogeriatric treatment has been associated with decreased mortality and a lower readmission rate [33] whereas such association has not been reported in other studies [2], including a randomized controlled trial [14]. In all these studies, the orthogeriatric intervention has lasted longer than in our study (i.e., for 1.5-2 weeks), and we are not aware of earlier studies concerning the effect of very short orthogeriatric intervention, like ours, on readmission rates, mortality or clinical outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…Hip fractures are a common and costly injury worldwide [ 1 ]. In older patients, hip fractures have also been associated with increased morbidity [ 2 ] and increased health care costs [ 3 ], and increased mortality [ 4 , 5 ]. From patients’ point of view, hip fracture often leads to decline in quality of life and functional ability and consequently there’s an increased need for assistance in daily living and many patients move to more assisted living environments [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

2020

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Aim To study the readmission rates and predictors of readmission following hip fracture surgery in a tertiary care centre with the very short postoperative length of stay. Findings Postoperative length of stay of only 1-2 days did not increase the risk of readmissions. Delay to surgery, prolonged length of stay, not receiving orthogeriatric contribution and discharge to primary rather than secondary care were associated higher readmission rate and/or mortality. Message Although a very short stay in the operating hospital appears safe, hip fracture patients should not be discharged to primary care wards with insufficient resources for managing the acute postoperative phase.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

2020

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“…Similar to our results, it has been shown that the implementation of multidisciplinary care improves clinical outcome of elderly patients after hip fracture [ 19 , 42 ]. Despite some literature indicating no advantages of ortho-geriatric interventions [ 43 ], the majority of published studies support GC by showing improved outcomes [ 40 , 42 , 44 ]. The advantages of interdisciplinary comanagement is mirrored by the comparable mortality despite increased medical complexity.…”

Section: Discussionmentioning

confidence: 99%

The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

Halvachizadeh

Gröbli²,

Berk

et al. 2021

PLoS ONE

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Introduction Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients. Methods This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization. Results This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%). Conclusion This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.

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“…Orthogeriatric care of injured old patients has been shown to have a positive influence on treatment’s outcome. 14 …”

Section: Introductionmentioning

confidence: 99%

Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients

Wiedl

Förch

Fenwick

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality. Methods: All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality. Results: 830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350). Discussion: In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk. Conclusions: The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.

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

Cited by 17 publications

References 37 publications

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients

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