The Economic Impact of Medical Complications in Geriatric Patients With Hip Fracture

Khasraghi, Fardin A; Lee, Eu Jin; Christmas, Colleen; Wenz, James F.

doi:10.3928/0147-7447-20030101-14

Cited by 36 publications

(4 citation statements)

References 42 publications

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“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS and 20 programs did not. Delayed TTS cutoffs were most often defined dichotomously as more than 24 hours, more than 36 hours, more than 48 hours, or more than 72 hours, although some studies collected continuous data.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

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Section: Resultsmentioning

confidence: 99%

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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“…Previous studies demonstrate that integrated orthogeriatric treatment is associated with a reduction in hospital mortality and long-term mortality rates [43][44][45][46][47][48]. A metaanalysis including 18 studies (9094 patients) concluded that combined orthopaedic and geriatrician care reduced mortality [13].…”

Section: Discussionmentioning

confidence: 99%

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population

Mant,

Amadi-Livingstone,

Ahmed

et al. 2024

Life

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Introduction: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Methods: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Results: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. Conclusion: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

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“…Asimismo, la determinación entre optar por la hemiartroplastía unipolar o bipolar es una consideración adicional crucial en el manejo de fracturas de cadera en personas mayores. Conforme el análisis de Khasraghi et al (2005), los pacientes sometidos a una hemiartroplastía bipolar reportaron resultados funcionales superiores y menor dolor postoperatorio en comparación con aquellos tratados con una hemiartroplastía unipolar. La selección entre estas alternativas podría depender de diversos factores, incluyendo la expectativa de vida del paciente, el grado de actividad física y la calidad ósea.…”

Section: Discussionunclassified

“Hemiartroplastia como tratamiento de elección para fractura intertrocanterica en el adulto mayor, breve revisión de la literatura”

Ramos-Miniguano,

Garay-Villamar

2023

MQRInvestigar

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Introducción: las fracturas intertrocantericas son una de las problemáticas ortopédicas predominantes en la cohorte de pacientes de edad avanzada. Agravadas por circunstancias como la desmineralización ósea y eventos de caída, se hace imperativo establecer modalidades terapéuticas que auspicien una restauración adecuada y duradera. Objetivo: esta revisión se propone sintetizar los hallazgos de la literatura acerca de la hemiartroplastia en su rol como tratamiento preferencial de las fracturas intertrocantericas en individuos gerontes, ponderando su viabilidad, ventajas y posibles desafíos. Metodología: se emprendió una indagación bibliográfica meticulosa en repositorios médicos de renombre, seleccionando investigaciones pertinentes que abordaran la implementación de la hemiartroplastia en el contexto de fracturas intertrocantericas en el segmento geriátrico. Los patrones de selección comprendieron ensayos clínicos, revisiones integrativas y metaanálisis divulgados en la última década. Resultados: la literatura avala la hemiartroplastia como una modalidad terapéutica solvente frente a las fracturas intertrocantericas en el anciano. Aquellos sometidos a este abordaje reflejaron una pronta restitución, episodios hospitalarios más breves y una atenuación en complicaciones posquirúrgicas al contrastar con otras modalidades. Las configuraciones unipolar y bipolar evidenciaron ventajas divergentes, acorde al cuadro clínico y al contexto. Conclusiones: la hemiartroplastia se consolida como un protocolo sobresaliente en el manejo de fracturas intertrocantericas en el estrato geriátrico, evidenciando ventajas tangibles en la recuperación y mitigación de adversidades. No obstante, la elección entre configuraciones unipolares y bipolares requiere de una deliberación ajustada al perfil individual del paciente. El corpus literario refrenda una inclinación favorable hacia la hemiartroplastia, reforzando su estatus como protocolo prioritario.

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The Economic Impact of Medical Complications in Geriatric Patients With Hip Fracture

Cited by 36 publications

References 42 publications

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population

“Hemiartroplastia como tratamiento de elección para fractura intertrocanterica en el adulto mayor, breve revisión de la literatura”

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