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01-01-2019 | Original Paper

Functional outcomes and mortality in geriatric and fragility hip fractures—results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”

Authors: Roberto Civinini, Tommaso Paoli, Luisella Cianferotti, Alessandro Cartei, Alberto Boccaccini, Adriano Peris, Maria Luisa Brandi, Carlo Rostagno, Massimo Innocenti

Published in: International Orthopaedics | Issue 1/2019

Abstract

Purpose

The aim of this study was to evaluate the outcomes of an integrated multidisciplinary hip fracture unit through the following parameters: time to surgery, mortality, return to activities of daily living, adherence to re-fractures prevention programs.

Methods

Six hundred seventy-seven consecutive patients with hip fracture were included in the study. We calculated the time to surgery as the time in hours from admission until surgery. The in-hospital mortality was calculated as the number of deaths that occurred before discharge. Each patient was then evaluated post-operatively at six weeks, three months, and one year. We studied basic activity of daily living (BADL) and the New Mobility Scale (NMS). Adherence to re-fractures prevention programs was also evaluated.

Results

88.9% of patients underwent surgery within two calendar days from admission. In-hospital mortality was 2.4%, and the overall mortality at one year from the intervention was 18.7%. Full mobility status or a low impairment of the mobility status was reached in 32.1% of the patients at one year and a level ≥ 3 of autonomy in BADL was reached in 62.4% (338/542) of patients. Three hundred forty-two patients were prescribed a specific therapy for secondary prevention of re-fracture.

Conclusions

An integrated, multidisciplinary model for the treatment of hip fragility fractures was effective in reducing time to surgery and mortality, increasing the level autonomy and mobility status and promoting adherence to re-fracture therapy.

Treml J, Kroker PB (2000) Hip fracture audit: time for standards to be evidence-based. Int Orthop 24:181–183CrossRefPubMedPubMedCentral

Innocenti M, Civinini R, Carulli C, Matassi F (2009) Proximal femural fractures: epidemiology. Clin Cases Miner Bone Metab 6:117–119PubMed

Gullberg B, Johnell O, Kanis J a (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413. https://doi.org/10.1007/PL00004148 CrossRefPubMed

Cooper C, Cole ZA, Holroyd CR et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288. https://doi.org/10.1007/s00198-011-1601-6 CrossRefPubMedPubMedCentral

Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250CrossRefPubMedPubMedCentral

Leibson CL, Tosteson ANA, Gabriel SE et al (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650CrossRefPubMed

Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S discussion 17S–19SCrossRefPubMed

Magaziner J, Hawkes W, Hebel JR et al (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507CrossRefPubMed

Suhm N, Kaelin R, Studer P et al (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134:1261–1269. https://doi.org/10.1007/s00402-014-2057-x CrossRefPubMed

10.

Kammerlander C, Roth T, Friedman SM et al (2010) Ortho-geriatric service--a literature review comparing different models. Osteoporos Int 21:S637–S646. https://doi.org/10.1007/s00198-010-1396-x CrossRefPubMed

11.

Giusti A, Barone A (2011) Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med 47:281–290PubMed

12.

British Orthopaedic Association (2007) The care of patients with fragility fractures. (Guideline ref ID: BOA2007). https://doi.org/10.1136/bmj.2.5211.1518

13.

Academy A, Board OS, September D (2014) Clinical practice guideline on the treatment of hip fracture in the elderly adopted by the American Academy of Orthopaedic Surgeons Board of Directors. Aaos

14.

Cianferotti L, Parri S, Gronchi G et al (2017) The use of cholecalciferol in patients with hip fracture. Clin Cases Miner Bone Metab 14:48–53. https://doi.org/10.11138/ccmbm/2017.14.1.048 CrossRefPubMedPubMedCentral

15.

Maier GS, Horas K, Seeger JB et al (2015) Vitamin D insufficiency in the elderly orthopaedic patient: an epidemic phenomenon. Int Orthop 39:787–792. https://doi.org/10.1007/s00264-014-2519-3 CrossRefPubMed

16.

Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg (Br) 75:797–798CrossRef

17.

Rostagno C, Cartei A, Civinini R, Prisco D (2018) Hip fracture unit: beyond orthogeriatrics. Intern Emerg Med 13:637–639. https://doi.org/10.1007/s11739-018-1818-x CrossRefPubMed

18.

Hughson J, Newman J, Pendleton RC (2011) Hip fracture management for the hospital-based clinician: a review of the evidence and best practices. Hosp Pract 39:52–61. https://doi.org/10.3810/hp.2011.02.374 CrossRef

19.

Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49–e55. https://doi.org/10.1097/BOT.0b013e3182a5a045 CrossRefPubMedPubMedCentral

20.

Moyet J, Deschasse G, Marquant B et al (2018) Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice. Int Orthop:1–6. https://doi.org/10.1007/s00264-018-3928-5

21.

Carow J, Carow JB, Coburn M et al (2017) Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis. Int Orthop 41:2371–2380. https://doi.org/10.1007/s00264-017-3639-3 CrossRefPubMed

22.

Stone AV, Jinnah A, Wells BJ et al (2018) Nutritional markers may identify patients with greater risk of re-admission after geriatric hip fractures. Int Orthop 42:231–238. https://doi.org/10.1007/s00264-017-3663-3 CrossRefPubMed

23.

Bliemel C, Buecking B, Oberkircher L et al (2017) The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients. Int Orthop 41:1995–2000. https://doi.org/10.1007/s00264-017-3591-2 CrossRefPubMed

24.

Forni C, Gazineo D, D’Alessandro F et al (2018) Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. Int Orthop. https://doi.org/10.1007/s00264-018-4057-x

25.

Shyu Y-IL, Liang J, Wu C-C et al (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53:811–818. https://doi.org/10.1111/j.1532-5415.2005.53253.x CrossRefPubMed

26.

Shyu Y-IL, Liang J, Wu C-C et al (2008) Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 63:92–97CrossRefPubMed

27.

Vidán M, Serra JA, Moreno C et al (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53:1476–1482. https://doi.org/10.1111/j.1532-5415.2005.53466.x CrossRefPubMed

28.

Friedman SM, Mendelson DA, Bingham KW, Kates SL (2009) Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med 169:1712–1717. https://doi.org/10.1001/archinternmed.2009.321 CrossRefPubMed

Title: Functional outcomes and mortality in geriatric and fragility hip fractures—results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”
Authors: Roberto Civinini
Tommaso Paoli
Luisella Cianferotti
Alessandro Cartei
Alberto Boccaccini
Adriano Peris
Maria Luisa Brandi
Carlo Rostagno
Massimo Innocenti
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4132-3

ACC 2024 Congress

Springer Medicine

Functional outcomes and mortality in geriatric and fragility hip fractures—results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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