Post-acute geriatric rehabilitation outcomes in fracture patients treated in an orthogeriatric trauma center-Aprospective investigation with historical control

Abstract

Despite the increasing amount of positive evidence with respect to mortality for the orthogeriatric co-management in a center for geriatric traumatology (CGT), effects on the course after the acute inpatient hospital treatment have been insufficiently investigated. Patients over 75 years old who needed rehabilitation following acute inpatient treatment before (retrospective, n = 90) and after (prospective, n = 99) the introduction of a certified CGT were investigated. The two groups were compared with respect to the frequency of discharge into an indication-specific (AHB) and geriatric rehabilitation, mobility performance including the five times sit-to-stand test, short physical performance battery (SPPB) and competence in activities of daily living with the Barthel index (BI). After introduction of a CGT 17.2% (95 % confidence interval [95 % CI]: 10-25%; p < 0.027) of the patients were discharged to a specialized orthopedic inpatient rehabilitation (AHB) vs. 6.7% (95 % CI: 1-12%) before the introduction. Correspondingly less patients needed geriatric rehabilitation (before CGT 93.3 %, 95 % CI: 88.1-98.6 vs. CGT 82.8 %, 95 % CI: 75-90; p < 0.001). The overall outcome of post-acute geriatric inpatient rehabilitation improved in both groups but did not differ. Patients who needed two therapy sessions in the CGT were clearly poorer than those with one therapy session with respect to activities of daily living (BI: 34.1, 95 % CI: 30-37.2 vs. 41.2, 95 % CI: 30.9-51.4) and mobility performance (SPPB: 1.2, 95 % CI: 0.7-1.8 vs. 2.2, 95 % CI: 0.9-3.4; p = 0.048). The differences remained despite improvement of both groups during geriatric rehabilitation. The establishment of aCGT enables more patients to be discharged into a less cost-intensive AHB. The more intensive treatment in the CGT offers more severely affected patients the chance for further functional improvement through post-acute inpatient geriatric rehabilitation. A predominantly closing treatment of patients in a CGT is not conceivable in the CGT model presented.