Ortho-geriatric service—a literature review comparing different models

Abstract

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients' treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

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“…In this context, we have to note that the mean age of our study population was 84.5 years and these patients have many co-morbid conditions. [40][41][42][43] These co-morbidities influence the recovery of the patients 41 and compared with the literature, [7][8][9] this is a satisfying outcome.…”

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“…A number of models of orthogeriatric care exist, but the joint care model (between geriatrician and orthopaedic surgeon on a dedicated orthogeriatric ward) has been shown to reduce inpatient mortality and decrease length of stay [33]. Recent work in Sweden [34] with a hip fracture patient cohort demonstrated significant reductions in mortality and readmission rates and provides compelling 'realworld' evidence for the efficacy of geriatric care at the healthcare system level.…”

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“…Kammerlander et al conducted a literature review comparing different models for combined care and found no best model. (11) They concluded that having integrated care, regardless of the model, can reduce in-hospital mortality, length of hospital stay and time to surgery. (11) Studies have shown that hip fracture patients should be surgically treated as soon as possible, within 48 hours, to reduce mortality and morbidity.…”

“…(11) They concluded that having integrated care, regardless of the model, can reduce in-hospital mortality, length of hospital stay and time to surgery. (11) Studies have shown that hip fracture patients should be surgically treated as soon as possible, within 48 hours, to reduce mortality and morbidity. (12)(13)(14) Khan et al conducted a systemic review of 52 published studies involving 291,413 patients and found that early surgery (defined as within 48 hours) resulted in no adverse outcomes, decreased length of hospital stay and probable reductions in complications and mortality.…”