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International Orthopaedics

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01-06-2021 | Original Paper

Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures

Authors: Pierre-Sylvain Marcheix, Camille Collin, Jérémy Hardy, Christian Mabit, Achille Tchalla, Jean-Louis Charissoux

Published in: International Orthopaedics | Issue 6/2021

Abstract

Introduction

Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture?

Methods and materials

Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit.

Results

Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant.

Discussion

Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1CrossRefPubMedPubMedCentral

Pablos-Hernandez C, Gonzalez-Ramirez A, da Casa C, Luis MM, Garcia-Iglesias MA, Julian-Enriquez JM, Rodriguez-Sanchez E, Blanco JF (2020) Time to surgery reduction in hip fracture patients on an integrated orthogeriatric unit: A comparative study of three healthcare models. Orthop Surg. https://doi.org/10.1111/os.12633

Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707. https://doi.org/10.1056/NEJM198812293192604CrossRefPubMed

Moyet J, Deschasse G, Marquant B, Mertl P, Bloch F (2019) 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 43(6):1449–1454. https://doi.org/10.1007/s00264-018-3928-5CrossRefPubMed

Maravic M, Taupin P, Landais P, Roux C (2011) Decrease of inpatient mortality for hip fracture in France. Joint Bone Spine 78(5):506–509. https://doi.org/10.1016/j.jbspin.2010.11.006CrossRefPubMed

Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A (2013) Predictors of early mortality after hip fracture surgery. Int Orthop 37(11):2119–2124. https://doi.org/10.1007/s00264-013-2068-1CrossRefPubMedPubMedCentral

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, MA MB, Cardiovascular Health Study Collaborative Research G (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156. https://doi.org/10.1093/gerona/56.3.m146CrossRefPubMed

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495. https://doi.org/10.1503/cmaj.050051CrossRefPubMedPubMedCentral

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762. https://doi.org/10.1016/S0140-6736(12)62167-9CrossRefPubMed

10.

Pioli G, Bendini C, Pignedoli P, Giusti A, Marsh D (2018) Orthogeriatric co-management - managing frailty as well as fragility. Injury 49(8):1398–1402. https://doi.org/10.1016/j.injury.2018.04.014CrossRefPubMed

11.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

12.

Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D, Blauth M (2010) Ortho-geriatric service--a literature review comparing different models. Osteoporos Int 21(Suppl 4):S637–S646. https://doi.org/10.1007/s00198-010-1396-xCrossRefPubMed

13.

Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482. https://doi.org/10.1111/j.1532-5415.2005.53466.xCrossRefPubMed

14.

Kristensen PK, Thillemann TM, Soballe K, Johnsen SP (2016) Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing 45(1):66–71. https://doi.org/10.1093/ageing/afv155CrossRefPubMed

15.

Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385(9978):1623–1633. https://doi.org/10.1016/S0140-6736(14)62409-0CrossRefPubMed

16.

Doshi HK, Ramason R, Azellarasi J, Naidu G, Chan WL (2014) Orthogeriatric model for hip fracture patients in Singapore: our early experience and initial outcomes. Arch Orthop Trauma Surg 134(3):351–357. https://doi.org/10.1007/s00402-013-1900-9CrossRefPubMed

17.

Boddaert J, Cohen-Bittan J, Khiami F, Le Manach Y, Raux M, Beinis JY, Verny M, Riou B (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One 9(1):e83795. https://doi.org/10.1371/journal.pone.0083795CrossRefPubMedPubMedCentral

18.

Pioli G, Bendini C, Giusti A, Pignedoli P, Cappa M, Iotti E, Ferri MA, Bergonzini E, Sabetta E (2019) Surgical delay is a risk factor of delirium in hip fracture patients with mild moderate cognitive impairment. Aging Clin Exp Res 31(1):41–47. https://doi.org/10.1007/s40520-018-0985-yCrossRefPubMed

19.

Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182(15):1609–1616. https://doi.org/10.1503/cmaj.092220CrossRefPubMedPubMedCentral

20.

Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7(10):e46175. https://doi.org/10.1371/journal.pone.0046175CrossRefPubMedPubMedCentral

21.

Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56(8):788–795. https://doi.org/10.1016/s0895-4356(03)00129-xCrossRefPubMed

22.

Neuman MD, Archan S, Karlawish JH, Schwartz JS, Fleisher LA (2009) The relationship between short-term mortality and quality of care for hip fracture: a meta-analysis of clinical pathways for hip fracture. J Am Geriatr Soc 57(11):2046–2054. https://doi.org/10.1111/j.1532-5415.2009.02492.xCrossRefPubMed

23.

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(18):1712–1717. https://doi.org/10.1001/archinternmed.2009.321CrossRefPubMed

24.

Bielza Galindo R, Ortiz Espada A, Arias Munana E, Velasco Guzman de Lazaro R, Mora Casado A, Moreno Martin R, Tapia Salinas B, Escalera Alonso J, Gomez Cerezo J (2013) Opening of an acute orthogeriatric unit in a general hospital. Rev Esp Geriatr Gerontol 48(1):26–29. https://doi.org/10.1016/j.regg.2012.03.002CrossRefPubMed

25.

Katrancha ED, Zipf J, Abrahams N, Schroeder R (2017) Retrospective evaluation of the impact of a geriatric trauma institute on fragility hip fracture patient outcomes. Orthop Nurs 36(5):330–334. https://doi.org/10.1097/NOR.0000000000000380CrossRefPubMed

26.

Hempsall VJ, Robertson DR, Campbell MJ, Briggs RS (1990) Orthopaedic geriatric care-is it effective? A prospective population-based comparison of outcome in fractured neck of femur. J R Coll Physicians Lond 24(1):47–50

27.

Bhattacharyya R, Agrawal Y, Elphick H, Blundell C (2013) A unique orthogeriatric model: A step forward in improving the quality of care for hip fracture patients. Int J Surg 11(10):1083–1086. https://doi.org/10.1016/j.ijsu.2013.09.018

28.

Gregersen M, Morch MM, Hougaard K, Damsgaard EM (2012) Geriatric intervention in elderly patients with hip fracture in an orthopedic ward. J Inj Violence Res 4(2):45–51. https://doi.org/10.5249/jivr.v4i2.96

29.

Pedersen SJ, Borgbjerg FM, Schousboe B, Pedersen BD, Jorgensen HL, Duus BR, Lauritzen JB, Hip Fracture Group of Bispebjerg H (2008) A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc 56(10):1831–1838. https://doi.org/10.1111/j.1532-5415.2008.01945.xCrossRefPubMed

30.

Duaso E, Formiga F, Marimon P, Sandiumenge M, Salgado MT, Murga V, Gamboa A, Rodriguez C, Castella J, Escalante E, Lumbreras C, Tarrida A, Sellares R (2018) Advantages of care for patients with hip fractures in the acute geriatric unit: Hip study Anoia. Geriatr Gerontol Int 18(3):407–414. https://doi.org/10.1111/ggi.13191CrossRefPubMed

31.

Dy CJ, Dossous PM, Ton QV, Hollenberg JP, Lorich DG, Lane JM (2012) The medical orthopaedic trauma service: an innovative multidisciplinary team model that decreases in hospital complications in patients with hip fractures. J Orthop Trauma 26(6):379–383. https://doi.org/10.1097/BOT.0b013e3182242678CrossRefPubMed

Title: Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures
Authors: Pierre-Sylvain Marcheix
Camille Collin
Jérémy Hardy
Christian Mabit
Achille Tchalla
Jean-Louis Charissoux
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04908-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures

Abstract

Introduction

Methods and materials

Results

Discussion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods and materials

Results

Discussion

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