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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2022

Open Access 01-12-2022 | Surgery | Original Article

The effectiveness of an orthogeriatric service in Ain Shams University, Egypt: a quality improvement study

Authors: Heba G. Saber, Menna A. E. G. Aly

Published in: Archives of Osteoporosis | Issue 1/2022

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Abstract

Summary

This quality improvement study assessed the effectiveness of an orthogeriatric service regarding fracture care and outcomes in terms of time to surgery, length of hospital stay, postoperative pain score improvement, depression and treatment decisions. The findings showed a significant reduction in time to surgery and mean length of stay following the implementation of orthogeriatric services (OGS).

Introduction

Osteoporosis is a metabolic bone disease prevalent amongst the elderly, more commonly females, and puts them at increased risk of fragility fractures. OGS are recommended as a model of best practice for primary and secondary fracture care.

Methods

This quality improvement study, conducted in our facility at Ain Shams University Hospital, Cairo, aimed to determine the effectiveness of an orthogeriatric service. We compared fracture care and outcomes before and after the implementation of OGS in terms of time to surgery, length of hospital stay, degree of postoperative pain score improvement, depression and treatment decisions. We included 128 patients aged 60 and above presenting to the emergency department with a fracture.

Results

We found a significant reduction in the median time to surgery in the post-OGS group (p < 0.001) and a significant decrease in the mean length of stay in favour of the post-OGS group (p < 0.001). However, no significant difference was found between the two groups regarding the number of patients treated operatively, degree of postoperative pain improvement or susceptibility to depression.

Conclusion

Since the orthogeriatric service began, preliminary data have been encouraging, with significant reductions in time to surgery and length of stay. This along with preoperative medical optimisation and collaborative discharge recommendations has improved overall patient outcomes even though more research is needed.
Literature
1.
2.
3.
Ekman EF (2010) The role of the orthopaedic surgeon in minimizing mortality and morbidity associated with fragility fractures. J Am Acad Orthop Surg 18(5):278–285CrossRefPubMed
4.
Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, McCloskey EV, Willers C, Borgström F (2021) SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos 16(1):1–82CrossRef
5.
Dreinhöfer KE et al (2018) A global call to action to improve the care of people with fragility fractures. Injury 49(8):1393–1397CrossRefPubMed
6.
British Orthopedic Association and British Geriatrics Society (2007) The care of patients with fragility fracture. British Orthopaedic Association, London
7.
8.
9.
10.
Bracey DN, Kiymaz TC, Holst DC et al (2016) An orthopedic-hospitalist comanaged hip fracture service reduces inpatient length of stay. Geriatric Orthopaedic Surg Rehab 7(4):171–177CrossRef
11.
Ogrinc G, Davies L, Goodman D, Batalden PB, Davidoff F, Stevens D (2016) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 25:986–992CrossRefPubMed
12.
Delaveau A, Saint-Genez F, Gayet LE, Paccalin M, Ounajim A, Vendeuvre T (2019) Impact of time to surgery in upper femoral fracture in orthogeriatrics. Orthopaedics Traumatol: Surg Res 105(5):975–8
13.
Zuckerman JD, Skovron ML, Koval KJ et al (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg 77A:1551–1556CrossRef
14.
Gdalevich M, Cohen D, Yosef D, Tauber C (2004) Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124(5):334–340CrossRefPubMed
15.
16.
Moja L, Piatti A, Pecoraro V et al (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):e46175CrossRefPubMedPubMedCentral
17.
Sheehan KJ, Sobolev B, Villán YF, Guy P (2017) Patient and system factors of time to surgery after hip fracture: a scoping review. BMJ open 7(8):e016939CrossRefPubMedPubMedCentral
18.
Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD (2004) Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthopaedics Related Res® 425:72–81CrossRef
19.
Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF Sr (2005) Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv 14(1):27–31PubMed
20.
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):1476–1482CrossRefPubMed
21.
Della Rocca GJ, Moylan KC, Crist BD, Volgas DA, Stannard JP, Mehr DR (2013) Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil 4(1):10–15CrossRefPubMed
22.
Leung AH, Lam TP, Cheung WH et al (2011) An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study. J Trauma 71(5):1390–1394PubMed
23.
Kates SL, Mendelson DA, Friedman SM (2010) Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int 21(4):621–625CrossRef
24.
Khan R, Fernandez C, Kashifl F, Shedden R, Diggory P (2002) Combined orthogeriatric care in the management of hip fractures: a prospective study. Ann R Coll Surg Engl 84(2):122–124PubMedPubMedCentral
25.
Wagner P, Fuentes P, Diaz A et al (2012) Comparison of complications and length of hospital stay between orthopedic and orthogeriatric treatment in elderly patients with a hip fracture. Geriatr Orthop Surg Rehabil 3(2):55–58CrossRefPubMedPubMedCentral
Metadata
Title
The effectiveness of an orthogeriatric service in Ain Shams University, Egypt: a quality improvement study
Authors
Heba G. Saber
Menna A. E. G. Aly
Publication date
01-12-2022
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-022-01144-3

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