Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice

Moyet, Julien; Deschasse, Guillaume; Marquant, B; Mertl, P.; Bloch, Frédéric

doi:10.1007/s00264-018-3928-5

Cited by 108 publications

(76 citation statements)

References 30 publications

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“…At first, one-year mortality was significantly reduced in patients being treated in the OGC unit compared to CTC. These results are in accordance with existing investigations on the impact of OGC and appear to be one of the major benefits attributed to OGC [12,14,[22][23][24]. Only 5 years ago comparative trials on the impact of orthogeriatic treatment on long-term mortality stated, that no significant differences were found in between the groups, while the number of comparative trials taken into account at that time was limited with relatively small study groups [11].…”

Section: Discussionsupporting

confidence: 89%

“…Only 5 years ago comparative trials on the impact of orthogeriatic treatment on long-term mortality stated, that no significant differences were found in between the groups, while the number of comparative trials taken into account at that time was limited with relatively small study groups [11]. A more recent meta-analysis conducted by Moyet et al showed that patients with hip fracture in the aging population admitted early into any sort of orthogeriatric models or more specifically to a dedicated orthogeriatric ward had reduced long-term mortality, while the authors also claimed, that randomised controlled trials on that topic are still missing [24]. Therefore, similar to hip replacement registries, there is a growing need for registries focusing trauma patients in the aging population such as the orthogeriatric trauma registry founded by the german trauma society (AltersTraumaRegister-DGU®).…”

Section: Discussionmentioning

confidence: 99%

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Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

et al. 2019

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Background: Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. Thus, an interdisciplinary orthogeriatric treatment of these patients has recognized a growing acceptance in the last years. As there is still limited data on the impact of this approach, the present study aimed to evaluate the long-term outcome in elderly hip fracture patients, by comparing the treatment of a hospital with integrated orthogeriatric care (OGC) with a conventional trauma care (CTC). Methods: We conducted a retrospective, two-center, cohort study. In two maximum care hospitals all patients presenting with a hip fracture at the age of ≥ 70 years were consecutively assigned within a 1 year period and underwent follow-up examination 12 months after surgery. Patients treated in hospital site A were treated with an interdisciplinary orthogeriatric approach (co-managed care), patients treated in hospital B underwent conventional trauma care. Main outcome parameters were 1 year mortality, readmission rate, requirement of care (RC) and personal activities of daily living (ADL). Results: A total of 436 patients were included (219 with OGC / 217 with CTC). The mean age was 83.55 (66-99) years for OGC and 83.50 (70-103) years for CTC (76.7 and 75.6% of the patients respectively were female). One year mortality rates were 22.8% (OGC) and 28.1% (CTC; p = 0.029), readmission rates were 25.7% for OGC compared to 39.7% for CTC (p = 0.014). Inconsistent data were found for activities of daily living. After 1 year, 7.8% (OGC) and 13.8% (CTC) of the patients were lost to follow-up. Conclusions: Interdisciplinary orthogeriatric management revealed encouraging impact on the long-term outcome of hip fracture patients in the aging population. The observed reduction of mortality, requirements of care and readmission rates to hospital clearly support the health-economic impact of an interdisciplinary orthogeriatric care on specialized wards. Trial registration: The study was approved and registered by the bavarian medical council (BLAEK: 7/11192) and the local ethics committee of munich university (Reg. No. 234-16) and was conducted as a two-center, cohort study at a hospital with integrated orthogeriatric care and a hospital with conventional trauma care.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

et al. 2019

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“…In the literature, the mortality rate remains between 20% and 30% in the year following a hip fracture. [17,18] We detected that a total of 4 patients had wound infection, 12 patients had the screw cut-out, 7 patients had heterotopic ossification, 11 patients had malunion or nonunion, 1 had a periprosthetic fracture, 1 had implant failure, and 1 had osteolysis with well-fixed implants in the follow-up process. There was no statistically significant difference between the groups in terms of these complications.…”

Section: Discussionmentioning

confidence: 98%

Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

Talmaç¹

2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures. METHODS:A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck-shaft angle, and loss of the abductor muscle strength. Data were compared between the groups. RESULTS:The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck-shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar. CONCLUSION:Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.

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“…FLSs comprise a multidisciplinary team members who together ensure people experiencing a fracture receive correct management and follow‐up . Other models of care, such as orthogeriatric care for patients with hip fracture, were shown to reduce mortality and morbidity compared with standard care . Fracture registries also provide valuable information that can be used to ensure care providers are delivering the best evidence‐based care …”

Section: Pharmacologic Managementmentioning

confidence: 99%

Osteoporosis in Older Persons: Old and New Players

Zanker

Duque

2018

J American Geriatrics Society

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Osteoporosis is the most common bone disease in humans. Older persons are at higher risk of osteoporotic fractures that also result in poor quality of life, disability, loss of independence, institutionalization, and higher mortality. Osteoporosis shares a distinct pathophysiologic relationship with sarcopenia, an age‐related disease comprising declines in muscle mass, strength, or function. The combination of these two diseases is known as osteosarcopenia. Understanding the pathophysiology of osteosarcopenia, in addition to its diagnostic and therapeutic approaches, is key in providing older adults with the best falls and fractures prevention strategies. This review provides updated information on new discoveries on the combined pathophysiology of osteoporosis and sarcopenia that have led to the development of novel therapeutic approaches. New recommendations for the use of risk calculators and densitometry are also presented in this review as well as evidence on current and upcoming pharmacologic treatments to prevent falls and fractures in older persons. J Am Geriatr Soc 67:831–840, 2019.

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Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice

Cited by 108 publications

References 30 publications

Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

Osteoporosis in Older Persons: Old and New Players

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