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BMC Geriatrics
Published in: BMC Geriatrics 1/2019

Open Access 01-12-2019 | Research article

The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study

Authors: Charlotte Abrahamsen, Birgitte Nørgaard, Eva Draborg, Morten Frost Nielsen

Published in: BMC Geriatrics | Issue 1/2019

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Abstract

Background

While orthogeriatric care to patients with hip fractures is established, the impact of similar intervention in patients with fragility fractures in general is lacking. Therefore, we aimed to assess the impact of an orthogeriatric intervention on postoperative complications and readmissions among patients admitted due to and surgically treated for fragility fractures.

Methods

A prospective observational cohort study with a retrospective control was designed. A new orthogeriatric unit for acute patients of sixty-five years or older with fragility fractures in terms of hip, vertebral or appendicular fractures was opened on March 1, 2014. Patients were excluded if the fracture was cancer-related or caused by high-energy trauma, if the patient was operated on at another hospital, treated conservatively with no operation, or had been readmitted within the last month due to fracture-related complications.

Results

We included 591 patients; 170 in the historical cohort and 421 in the orthogeriatric cohort. No significant differences were found between the two cohorts with regard to the proportion of participants experiencing complications (24.5% versus 28.3%, p = 0.36) or readmission within 30 days after discharge (14.1% vs 12.1%, p = 0.5). With both cohorts collapsed and adjusting for age, gender and CCI, the odds of having postoperative complications as a hip fracture patient was 4.45, compared to patients with an appendicular fracture (p <  0.001). Furthermore, patients with complications during admission were at a higher risk of readmission within 30 days than were patients without complications (22.3% vs 9.5%, p <  0.001).

Conclusions

In older patients admitted with fragility fractures, our model of orthogeriatric care showed no significant differences regarding postoperative complications or readmissions compared to the traditional care. However, we found significantly higher odds of having postoperative complications among patients admitted with a hip fracture compared to other fragility fractures. Additionally, our study reveals an increased risk of being readmitted within 30 days for patients with postoperative complications.
Literature
1.
Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51(3):364–70.PubMedCrossRef
2.
3.
Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, et al. Ortho-geriatric service--a literature review comparing different models. Osteoporos Int. 2010;21(Suppl 4):S637–46.PubMedCrossRef
4.
Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM. Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma. 2006;20(3):172–8 discussion 179-180.PubMedCrossRef
5.
Folbert EC, Smit RS, van der Velde D, Regtuijt EM, Klaren MH, Hegeman JH. Geriatric fracture center: a multidisciplinary treatment approach for older patients with a hip fracture improved quality of clinical care and short-term treatment outcomes. Geriatr Orthop Surg Rehabil. 2012;3(2):59–67.PubMedPubMedCentralCrossRef
6.
Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169(18):1712–7.PubMedCrossRef
7.
Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF Sr. Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv. 2005;14(1):27–31.PubMed
8.
Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005;53(9):1476–82.PubMedCrossRef
9.
Dy CJ, Dossous PM, Ton QV, Hollenberg JP, Lorich DG, Lane JM. The medical orthopaedic trauma service: an innovative multidisciplinary team model that decreases in-hospital complications in patients with hip fractures. J Orthop Trauma. 2012;26(6):379–83.PubMedCrossRef
10.
Katrancha ED, Zipf J, Abrahams N, Schroeder R. Retrospective evaluation of the impact of a geriatric trauma institute on fragility hip fracture patient outcomes. Orthop Nurs. 2017;36(5):330–4.PubMedCrossRef
11.
Duaso E, Formiga F, Marimon P, Sandiumenge M, Salgado MT, Murga V, et al. Advantages of care for patients with hip fractures in the acute geriatric unit: hip study Anoia. Geriatr Gerontol Int. 2018;18(3):407–14.PubMedCrossRef
12.
Barone A, Giusti A, Pizzonia M, Razzano M, Palummeri E, Pioli G. A comprehensive geriatric intervention reduces short- and long-term mortality in older people with hip fracture. J Am Geriatr Soc. 2006;54(7):1145–7.PubMedCrossRef
13.
Leung AH, Lam TP, Cheung WH, Chan T, Sze PC, Lau T, et al. An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study. J Trauma. 2011;71(5):1390–4.PubMedCrossRef
14.
Zeltzer J, Mitchell RJ, Toson B, Harris IA, Ahmad L, Close J. Orthogeriatric services associated with lower 30-day mortality for older patients who undergo surgery for hip fracture. Med J Aust. 2014;201(7):409–11.PubMedCrossRef
15.
Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int. 2019;30(4):907–16.PubMedCrossRef
16.
Forni S, Pieralli F, Sergi A, Lorini C, Bonaccorsi G, Vannucci A. Mortality after hip fracture in the elderly: the role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Arch Gerontol Geriatr. 2016;66:13–7.PubMedCrossRef
17.
Lips, P. (1997). "epidemiology and predictors of fractures associated with osteoporosis." am J med 103(2a): 3S-8S; discussion 8S-11S.
18.
19.
Sabharwal S, Wilson H. Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteoporos Int. 2015;26(10):2387–99.PubMedCrossRef
20.
Kammerlander C, Gosch M, Blauth M, Lechleitner M, Luger TJ, Roth T. The Tyrolean geriatric fracture center: an orthogeriatric co-management model. Z Gerontol Geriatr. 2011;44(6):363–7.PubMedCrossRef
21.
Chong C, Christou J, Fitzpatrick K, Wee R, Lim WK. Description of an orthopedic-geriatric model of care in Australia with 3 years data. Geriatr Gerontol Int. 2008;8(2):86–92.PubMedCrossRef
22.
Adams AL, Schiff MA, Koepsell TD, Rivara FP, Leroux BG, Becker TM, et al. Physician consultation, multidisciplinary care, and 1-year mortality in Medicare recipients hospitalized with hip and lower extremity injuries. J Am Geriatr Soc. 2010;58(10):1835–42.PubMedCrossRef
23.
Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, et al. Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury. 2013;44(11):1403–12.PubMedCrossRef
24.
Khasraghi FA, Lee EJ, Christmas C, Wenz JF. The economic impact of medical complications in geriatric patients with hip fracture. Orthopedics. 2003;26(1):49–53 discussion 53.PubMed
25.
Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. Bmj. 2005;331(7529):1374.PubMedPubMedCentralCrossRef
26.
Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Cmaj. 2002;167(10 Suppl):S1–34.PubMedPubMedCentral
27.
Foss NB, Kristensen MT, Kehlet H. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil. 2006;20(8):701–8.PubMedCrossRef
28.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef
29.
Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sorensen HT. The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of patients. BMC Med Res Methodol. 2011;11:83.PubMedPubMedCentralCrossRef
30.
Liem IS, Kammerlander C, Suhm N, Kates SL, Blauth M. Literature review of outcome parameters used in studies of geriatric fracture centers. Arch Orthop Trauma Surg. 2014;134(2):181–7.PubMedCrossRef
31.
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc. 2011;59(7):1299–308.PubMedCrossRef
32.
Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med. 2007;39(3):232–8.PubMedCrossRef
33.
Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to United States government data. Geriatr Orthop Surg Rehabil. 2010;1(1):15–21.PubMedPubMedCentralCrossRef
34.
Kua J, Ramason R, Rajamoney G, Chong MS. Which frailty measure is a good predictor of early post-operative complications in elderly hip fracture patients? Arch Orthop Trauma Surg. 2016;136(5):639–47.PubMedCrossRef
35.
Pedersen SJ, Borgbjerg FM, Schousboe B, Pedersen BD, Jorgensen HL, Duus BR, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc. 2008;56(10):1831–8.PubMedCrossRef
36.
Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56(7):1349–56.PubMedCrossRef
37.
Biber R, Singler K, Curschmann-Horter M, Wicklein S, Sieber C, Bail HJ. Implementation of a co-managed geriatric fracture center reduces hospital stay and time-to-operation in elderly femoral neck fracture patients. Arch Orthop Trauma Surg. 2013;133(11):1527–31.PubMedCrossRef
38.
Metadata
Title
The impact of an orthogeriatric intervention in patients with fragility fractures: a cohort study
Authors
Charlotte Abrahamsen
Birgitte Nørgaard
Eva Draborg
Morten Frost Nielsen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2019
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-019-1299-4

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