Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients.

Andreas Wiedl,Annabel Fenwick,Edgar Mayr,Stefan Förch

doi:10.1177/2151459321998314

Andreas Wiedl, Annabel Fenwick + Show 2 more

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https://doi.org/10.1177/2151459321998314

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Abstract

Introduction:Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality.Methods:All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality.Results:830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350).Discussion:In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk.Conclusions:The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.

Highlights

Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures
Gender, type of fracture, Parker Mobility Score (PMS), Activities of daily living (ADL), CharlsonComorbidity-Index (CCI), preexisting dementia and sarcopenia as influential factors on the occurrence and associated mortality of the investigated complications
The goal of this study was to determine incidences and risk factors of common complications associated to inpatient orthogeriatric treatment of fragility fractures and their impact on the patients’ mortality

Summary

Introduction

Thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. Pneumonia was identified as a significant risk factor for increased mortality after hip fractures,[9,10] whereas urogenital infections were not observed to influence survival in a negative way.[7,11] The occurrence of acute kidney failure and the stage of preexisting chronic kidney failure seem to correlate with higher mortality.[12] Delirium and associated negative consequences such as falls and noncompliance are typical in the inpatient context too.[13] In order to address comorbidities and complications, orthogeriatric treatment was widely established. Orthogeriatric care of injured old patients has been shown to have a positive influence on treatment’s outcome.[14]

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