Abstract
SummaryBackgroundClinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals.MethodsThis non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality.FindingsThere were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01).InterpretationCo-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence.FundingThe study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071).
Highlights
Hip fracture is a common and severe injury among older people, those with existing osteoporosis, imposing a huge burden on patients and health systems, due to high mortality, severe disability, loss of independence, long hospital stay, and excess medical costs.[1,2,3] The UK “Blue Book”, jointly developed by the British Orthopaedic Association and British Geriatric Society, is considered as the best practice for the management of older hip fracture patients in many countries.[4]
Implication of all the available evidence. This is the first multicentre, prospective, controlled study to evaluate the effect of an orthogeriatric co-management care model in China. This care model significantly reduced the time from ward admission to surgery, improved many outcomes for better hip fracture management as well as showed a promise to reduce in-hospital and one-year cumulative mortality
A meta-analysis demonstrated that surgery within 48 hours of admission significantly reduced mortality risk in hip fracture patients (OR=0.74, 95% confidence interval [CI] 0.67 to 0.81),[5] while another study showed that orthogeriatric care was associated with a significant reduction of in-hospital mortality (RR=0.60, 95% CI 0.43 to 0.84).[6]
Summary
Hip fracture is a common and severe injury among older people, those with existing osteoporosis, imposing a huge burden on patients and health systems, due to high mortality, severe disability, loss of independence, long hospital stay, and excess medical costs.[1,2,3] The UK “Blue Book”, jointly developed by the British Orthopaedic Association and British Geriatric Society, is considered as the best practice for the management of older hip fracture patients in many countries.[4]. This single-centre, retrospective, “pre- and post-” study without parallel controls and follow-up data limited the scope of interpreting the research findings
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