Orthogeriatric co-management improves the outcome of long-term care residents with fragility fractures

Abstract

BackgroundFragility fractures are a major health care problem worldwide. Both hip and non-hip fractures are associated with excess mortality in the years following the fracture. Residents of long-term nursing homes represent a special high-risk group for poor outcomes. Orthogeriatric co-management models of care have shown in multiple studies to have medical as well as economic advantages, but their impact on this high-risk group has not been well studied.ObjectiveWe studied the outcome of long-term care residents with hip and non-hip fractures admitted to a geriatric fracture center.MethodsThe study design is a single center, prospective cohort study at a level-I trauma center in Austria running a geriatric fracture center. The cohort included all fragility fracture patients aged over 70 admitted from a long-term care residence from May 2009 to November 2011. The data set consisted of 265 patients; the mean age was 86.8 ± 6.7 years, and 80 % were female. The mean follow-up after the index fracture was 789 days, with a range from 1 to 1842 days. Basic clinical and demographic data were collected at hospital admission. Functional status and mobility were assessed during follow-up at 3, 6, and 12 months. Additional outcome data regarding readmissions for new fractures were obtained from the hospital information database; mortality was crosschecked with the death registry from the governmental institute of epidemiology.Results187 (70.6 %) patients died during the follow-up period, with 78 patients (29.4 %) dying in the first year. The mean life expectancy after the index fracture was 527 (±431) days. Differences in mortality rates between hip and non-hip fracture patients were not statistically significant. Compared to reported mortality rates in the literature, hip fracture patients in this orthogeriatric-comanaged cohort had a significantly reduced one-year mortality [OR of 0.57 (95 % CI 0.31–0.85)]. After adjustment for confounders, only older age (OR 1.091; p = 0.013; CI 1.019–1.169) and a lower Parker Mobility Scale (PMS) (OR 0.737; p = 0.022; CI 0.568–0.957) remained as independent predictors. During follow-up, 62 patients (23.4 %) sustained at least one subsequent fracture, and 10 patients (3.4 %) experienced multiple fractures; 29 patients (10.9 %) experienced an additional fracture within the first year. Nearly, half (47.1 %) regained their pre-fracture mobility based on the PMS.ConclusionDespite the generally poor outcomes for fragility fracture patients residing in long-term care facilities, orthogeriatric co-management appears to improve the outcome of high-risk fragility fracture patients. One-year mortality was 29.4 % in this cohort, significantly lower than in comparable trials. Orthogeriatric co-management may also have positive impacts on both functional outcome and the risk of subsequent fractures.

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

“…Since the development of the Hastings care model, we have learned that collaboration between the trauma team and the geriatric team may improve the treatment of patients with hip fractures. Several publications indicate that collaborative models between geriatricians and surgeons could improve the results of the treatment of this pathology.…”

Does Comanagement of Patients With Hip Fracture Influence 30-Day Outcomes

“…Despite medical and surgical management, often focused on these risk factors, the mortality rate remains high. 9 Nevertheless, it is crucial to continue to try to optimize the care of these high-risk patients. Perioperative management has traditionally been performed by orthopedic surgeons, yet with the comorbidities and complications of hospitalization, medicine physicians or geriatricians may be better suited to provide care outside of fracture surgery.…”

A Protocol for the Management of the Inpatient Fracture Neck of Femur is Required

“…Delays in operative management have also been shown to lead to an increased risk of deep vein thrombosis [20]. An early assessment by a specialist Orthogeriatrician, focussing on optimising medical issues which would otherwise delay operative management, is therefore essential as this has been demonstrated to improve patient outcome [21, 22]. As a result of their co-morbidities, inpatients suffering hip fractures are more likely to have their procedures postponed due to medical issues, or have a significant delay in their diagnosis either due to imaging not being performed in a timely fashion or because further imaging is required [6, 13].…”