Abstract
BackgroundHip 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).MethodsWe 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).ResultsA 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.ConclusionsInterdisciplinary 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 registrationThe 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.
Highlights
Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging
A total of 480 patients were screened for eligibility, 231 following orthogeriatric care (OGC) and 249 after conventional trauma care (CTC)
Twelve patients at OGC and 32 patients at CTC were excluded as they underwent surgery in another hospital and were transferred thereafter to one of the study hospitals or as they presented preoperative with an American Society of Anaesthesiologists (ASA) score of 4 or 5 and were in critical condition, regardless of the type of treatment (Fig. 1; Legend: “Flowchart of patients who met inclusion criteria for the study”)
Summary
Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. To broadly address the complex needs of older trauma patients, special treatment models have been developed, merging the expertise of geriatricians and orthopaedic surgeons in different ways [8] Out of these models, full integration of a geriatrician in the team of orthopaedic surgeons is expected to be the most effective approach for interdisciplinary treatment [9] and was often established within the last years [8]. The majority of recent studies investigating the impact of orthogeriatric care (OGC) were retrospective studies, using data before and after the implementation of OGC [12,13,14] They demonstrated improved 30-day mortality as well as 1 year mortality. Other present investigations chose strict in−/exclusion criteria such as exclusion of cognitive disordered patients, which might not reflect the typical orthogeriatric population
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