Abstract
Orthogeriatrics is increasingly recommended in the care of hip fracture patients, although evidence for this model is conflicting or at least limited. Furthermore, there is no conclusive evidence on which model [geriatric medicine consultant service (GCS), geriatric medical ward with orthopedic surgeon consultant service (GW), integrated care model (ICM)] is superior. The review summarizes the effect of orthogeriatric care for hip fracture patients on length of stay (LOS), time to surgery (TTS), in-hospital mortality, 1-year mortality, 30-day readmission rate, functional outcome, complication rate, and cost. Two independent reviewers retrieved randomized controlled trials, controlled observational studies, and pre/post analyses. Random-effects meta-analysis was performed. Thirty-seven studies were included, totaling 37.294 patients. Orthogeriatric care significantly reduced LOS [mean difference (MD) − 1.55 days, 95% confidence interval (CI) (− 2.53; − 0.57)], but heterogeneity warrants caution in interpreting this finding. Orthogeriatrics also resulted in a 28% lower risk of in-hospital mortality [95%CI (0.56; 0.92)], a 14% lower risk of 1-year mortality [95%CI (0.76; 0.97)], and a 19% lower risk of delirium [95%CI (0.71; 0.92)]. No significant effect was observed on TTS and 30-day readmission rate. No consistent effect was found on functional outcome. Numerically lower numbers of complications were observed in orthogeriatric care, yet some complications occurred more frequently in GW and ICM. Limited data suggest orthogeriatrics is cost-effective. There is moderate quality evidence that orthogeriatrics reduces LOS, in-hospital mortality, 1-year mortality, and delirium of hip fracture patients and may reduce complications and cost, while the effect on functional outcome is inconsistent. There is currently insufficient evidence to recommend one or the other type of orthogeriatric care model.
Highlights
Hip fractures are the most devastating type of fragility fractures in older patients, as they contribute most to the morbidity, mortality, and economic cost associated with fragility fractures [1]
The research question was constructed using the Population, Intervention, Control, Outcome (PICO) procedure: “In older hip fracture patients, what is the effect of different orthogeriatric care models on a selection of outcome parameters?” A search string was developed with the keywords ‘orthogeriatric care models,’ ‘hip fracture,’ ‘femur fracture,’ and ‘osteoporosis.’ Full search strings are available in Supplementary data S1
The effect of orthogeriatric care on functional outcome was inconsistent, with patients admitted to integrated care model (ICM) as well as to geriatric medical ward (GW) and geriatric medicine consult service (GCS) showing better activity of daily living (ADL) performance or no difference compared to standard of care (SOC)
Summary
Hip fractures are the most devastating type of fragility fractures in older patients, as they contribute most to the morbidity, mortality, and economic cost associated with fragility fractures [1]. By the year 2050, the worldwide incidence of hip fractures is expected to increase by 310% for men and by 240% for women because of the aging of the population and age-related increase in fracture risk. The latter is the result of age-associated increase in the prevalence of osteoporosis and the risk of falling, with about 25% of women and 15% of men aged ≥ 80 years reporting at least one fall in the past 6 months [2, 3]. This long-term excess mortality is explained by the fact that older hip fracture patients are frail persons, who are at increased risk of comorbidity and functional deficits [7]. One year after a fracture, 40% of patients are unable to walk independently and 60% experience difficulties in at least one activity of daily living (ADL) [8]
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