The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults.
Aged
Aged, 80 and over
Delivery of Health Care, Integrated
/ organization & administration
Female
Fracture Fixation
/ methods
Geriatric Assessment
/ methods
Health Services for the Aged
/ organization & administration
Hip Fractures
/ complications
Humans
Italy
Length of Stay
/ statistics & numerical data
Male
Models, Organizational
Osteoporotic Fractures
/ complications
Patient Care Team
/ organization & administration
Trauma Centers
/ organization & administration
Treatment Outcome
Hip fracture
Models of care
Mortality
Orthogeriatric
Outcomes
Journal
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
ISSN: 1433-2965
Titre abrégé: Osteoporos Int
Pays: England
ID NLM: 9100105
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
07
07
2018
accepted:
15
01
2019
pubmed:
5
2
2019
medline:
18
12
2019
entrez:
5
2
2019
Statut:
ppublish
Résumé
Treatment of older adults with hip fracture is a healthcare challenge. Orthogeriatric comanagement that is an integrated model of care with shared responsibility improves time to surgery and reduces the length of hospital stay and mortality compared with orthopedic care with geriatric consultation service and usual orthopedic care, respectively. Treatment of fractures in older adults is a clinical challenge due partly to the presence of comorbidity and polypharmacy. The goal of orthogeriatric models of care is to improve clinical outcomes among older people with hip fractures. We compare clinical outcomes of persons with hip fracture cared according to orthogeriatric comanagement (OGC), orthopedic team with the support of a geriatric consultant service (GCS), and usual orthopedic care (UOC). This is a single-center, pre-post intervention observational study with two parallel arms, OGC and GCS, and a retrospective control arm. Hip fracture patients admitted to the trauma ward were assigned by the orthopedic surgeon to the OGC (n = 112) or GCS (n = 108) group. The intervention groups were compared each with others and both with the retrospective control group (n = 210) of older adults with hip fracture. Several clinical indicators are considered, including time to surgery, length of stay, in-hospital, and 1-year mortality. Patients in the OGC (OR 2.62; CI 95% 1.40-4.91) but not those in the GCS (OR 0.74; CI 95% 0.38-1.47) showed a higher probability of undergoing surgery within 48 h compared with those in the UOC. Moreover, the OGC (β, - 1.08; SE, 0.54, p = 0.045) but not the GCS (β, - 0.79; SE, 0.53, p = 0.148) was inversely associated with LOS. Ultimately, patients in the OGC (OR 0.31; CI 95 % 0.10-0.96) but not those in the GCS (OR 0.37; CI 95% 0.10-1.38) experienced a significantly lower 1-year mortality rate compared with those in the UOC. All analyses were independent of several confounders. Older adults with hip fracture taken in care by the OGC showed better clinical indicators, including time to surgery, length of stay and mortality, than those managed by geriatric consultant service or usual orthopedic care.
Identifiants
pubmed: 30715561
doi: 10.1007/s00198-019-04858-2
pii: 10.1007/s00198-019-04858-2
doi:
Types de publication
Journal Article
Observational Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-916Références
J Am Geriatr Soc. 2000 Jun;48(6):618-24
pubmed: 10855596
Ann R Coll Surg Engl. 2002 Mar;84(2):122-4
pubmed: 11995752
CMAJ. 2002 Jul 9;167(1):25-32
pubmed: 12137074
Orthopedics. 2003 Jan;26(1):49-53; discussion 53
pubmed: 12555834
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
J Gerontol A Biol Sci Med Sci. 2004 May;59(5):473-7
pubmed: 15123758
J Surg Orthop Adv. 2005 Spring;14(1):27-31
pubmed: 15766439
J Am Geriatr Soc. 2005 Sep;53(9):1476-82
pubmed: 16137275
J Am Geriatr Soc. 2006 Jul;54(7):1145-7
pubmed: 16866692
J Bone Miner Res. 2007 Mar;22(3):465-75
pubmed: 17144789
J Gerontol A Biol Sci Med Sci. 2008 Jan;63(1):92-7
pubmed: 18245766
J Am Geriatr Soc. 2008 Jul;56(7):1349-56
pubmed: 18503520
J Am Geriatr Soc. 2009 Jan;57(1):159-67
pubmed: 19054192
Osteoporos Int. 2009 Oct;20(10):1633-50
pubmed: 19421703
J Trauma. 2009 May;66(5):1402-10
pubmed: 19430246
Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007125
pubmed: 19821396
Arch Intern Med. 2009 Oct 12;169(18):1712-7
pubmed: 19822829
Australas J Ageing. 2009 Dec;28(4):171-6
pubmed: 19951337
J Am Geriatr Soc. 2009 Nov;57(11):2153-4
pubmed: 20121961
Hip Int. 2010 Apr-Jun;20(2):229-35
pubmed: 20544649
CMAJ. 2010 Oct 19;182(15):1609-16
pubmed: 20837683
Osteoporos Int. 2010 Dec;21(Suppl 4):S637-46
pubmed: 21058004
J Am Med Dir Assoc. 2011 Jul;12(6):439-44
pubmed: 21450210
Osteoporos Int. 2011 May;22(5):1277-88
pubmed: 21461721
J Inj Violence Res. 2012 Jul;4(2):45-51
pubmed: 21502786
Eur J Phys Rehabil Med. 2011 Jun;47(2):281-96
pubmed: 21555985
Clinics (Sao Paulo). 2012;67(6):547-56
pubmed: 22760891
Injury. 2013 Jun;44(6):726-9
pubmed: 23010072
Clin Interv Aging. 2012;7:575-83
pubmed: 23269863
Injury. 2013 Nov;44(11):1403-12
pubmed: 23880377
J Orthop Trauma. 2014 Mar;28(3):e49-55
pubmed: 23912859
Hip Int. 2013 Nov-Dec;23(6):570-5
pubmed: 23934901
Clin Geriatr Med. 2014 May;30(2):183-9
pubmed: 24721359
J R Coll Physicians Edinb. 2014;44(1):20-6
pubmed: 24995442
Osteoporos Int. 2014 Nov;25(11):2591-7
pubmed: 25011985
Arch Orthop Trauma Surg. 2014 Sep;134(9):1261-9
pubmed: 25060921
Lancet. 2015 Apr 25;385(9978):1623-33
pubmed: 25662415
BMC Geriatr. 2016 Sep 02;16:158
pubmed: 27590604
Age Ageing. 2017 May 1;46(3):465-470
pubmed: 27974304
J Orthop Sci. 2017 Sep;22(5):909-914
pubmed: 28728988
BMJ. 1988 Oct 29;297(6656):1083-6
pubmed: 3143436
BMJ. 1988 Oct 29;297(6656):1116-8
pubmed: 3143450
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Injury. 1983 Nov;15(3):193-6
pubmed: 6642632
Med J Aust. 1998 Nov 16;169(10):515-8
pubmed: 9861907