Hip fracture management and outcomes in Italy

Abstract

Hip fractures are a major health care problem in Italy since more than 90,000 such fractures per year occur among elderly people. Nowadays, in several boroughs, orthopaedic wards are being restructured, overcoming the traditional model of care towards heterogeneous liaison models between the orthopaedic staff and medical-geriatric staff. However, the care pathway changes considerably from one area to another of the country. Wide differences in the choice of treatment, surgical delays, length of in-hospital stay and the availability of rehabilitation services and intermediate care in the sub-acute period have been reported over the country. The authors described the orthogeriatric model of Arcispedale Santa Maria Nuova (ASMN) Hospital, the main hospital of the province of Reggio Emilia (Emilia-Romagna region), implemented in 2007 for all patients aged 75 years and older admitted with a hip fracture. During hospital stay each patient is comanaged by an orthopedic surgeon and a geriatrician with different responsibility and using a number of evidence-based protocols and standardized procedures. Even without dedicated trauma theatre, comparing data before and after the implementation of the Ortho-Geriatric model, a 50% reduction of waiting time to surgery was observed and the mean hospital stay decreased about 5 days. The Ortho-Geriatric approach should include all those strategies and interventions that have been shown to improve outcomes in well-designed and strictly evidence-based studies and the ASMN model need to be improved in several critical aspects such as standardized approaches in the management of the patients with very high level of comorbidity in the preoperative phase and the coordination of all the medical staff in the presurgical period.