Abstract
Background and Objectives: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU®). Materials and Methods: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). Results: Patients in the post-GTC group (n = 111) were older (median age 82.0 years) compared to the pre-GTC group (n = 108, median age 80.0 years, p = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all p > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, p = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, p = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, p = 0.094), while an ACDiT score of ≥1 was comparable between groups (p = 0.169). Conclusions: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.
Highlights
The incidence of fragility fracture patients is rising, especially in more economically developed countries
ISAR screening was performed in 90.74% of patients, and 69.4% reached the cut-off score (≥2), proving the need for orthogeriatric co-management (OGCM)
No significant difference was observed between groups for ASA class (p = 0.475), with more patients classified as ASA 3 or higher
Summary
The incidence of fragility fracture patients is rising, especially in more economically developed countries. Fragility fractures occur mainly in the aging population, causing a high disease burden [1,2,3]. It is estimated that 30–50% of all people over 50 years old will suffer at least one osteoporosis-associated vertebral body fracture [4]. In industrialised countries, geriatric pelvic ring fractures, which are associated with long-term reduced mobility and quality of life [5], have significantly increased over the past 50 years and are predicted to increase by 2.4-fold by the year 2030 [6]. Medical complexity of geriatric trauma patients has significantly increased during the last decade [7]. The elderly have an overall greater risk of in-hospital complications [8] and a threefold higher mortality rate as compared to younger patients [9,10]
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