Abstract
Summary
Treatment of older adults with hip fracture is a healthcare challenge. Orthogeriatric comanagement that is an integrated model of care with shared responsibility improves time to surgery and reduces the length of hospital stay and mortality compared with orthopedic care with geriatric consultation service and usual orthopedic care, respectively.
Introduction
Treatment of fractures in older adults is a clinical challenge due partly to the presence of comorbidity and polypharmacy. The goal of orthogeriatric models of care is to improve clinical outcomes among older people with hip fractures. We compare clinical outcomes of persons with hip fracture cared according to orthogeriatric comanagement (OGC), orthopedic team with the support of a geriatric consultant service (GCS), and usual orthopedic care (UOC).
Methods
This is a single-center, pre-post intervention observational study with two parallel arms, OGC and GCS, and a retrospective control arm. Hip fracture patients admitted to the trauma ward were assigned by the orthopedic surgeon to the OGC (n = 112) or GCS (n = 108) group. The intervention groups were compared each with others and both with the retrospective control group (n = 210) of older adults with hip fracture. Several clinical indicators are considered, including time to surgery, length of stay, in-hospital, and 1-year mortality.
Results
Patients in the OGC (OR 2.62; CI 95% 1.40–4.91) but not those in the GCS (OR 0.74; CI 95% 0.38–1.47) showed a higher probability of undergoing surgery within 48 h compared with those in the UOC. Moreover, the OGC (β, − 1.08; SE, 0.54, p = 0.045) but not the GCS (β, − 0.79; SE, 0.53, p = 0.148) was inversely associated with LOS. Ultimately, patients in the OGC (OR 0.31; CI 95 % 0.10–0.96) but not those in the GCS (OR 0.37; CI 95% 0.10–1.38) experienced a significantly lower 1-year mortality rate compared with those in the UOC. All analyses were independent of several confounders.
Conclusions
Older adults with hip fracture taken in care by the OGC showed better clinical indicators, including time to surgery, length of stay and mortality, than those managed by geriatric consultant service or usual orthopedic care.
Similar content being viewed by others
References
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20(10):1633–1650
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, Fragility fracture network (FFN) rehabilitation research special interest group (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA, IOF CSA Working Group on Fracture Epidemiology (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288
Piscitelli P, Iolascon G, Argentiero A et al (2012) Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging 7:575–583
Marcantonio ER, Flacker JM, Michaels M, Resnick NM (2000) Delirium is independently associated with poor functional recovery after hip fracture. 48:618–624
Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616
Uzoigwe CE, Burnand HG, Cheesman CL, Aghedo DO, Faizi M, Middleton RG (2013) Early and ultra-early surgery in hip fracture patients improves survival. Injury 44:726–729
Khasraghi FA, Lee EJ, Christmas C, Wenz JF (2003) The economic impact of medical complications in geriatric patients with hip fracture. Orthopedics 26:49–53
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475
Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49–e55
Giusti A, Barone A, Razzano M, Pioli G (2011) Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med 47:281–296
Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D, Blauth M (2010) Ortho-geriatric service-a literature review comparing different models. Osteoporos Int 21:S637–S646
Handoll HH, Cameron ID, Mak JC, Finnegan TP (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 7(4):Cd007125
Friedman SM, Mendelson DA, Kates SL, RM MC (2008) 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 56:1349–1356
Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385:1623–1633
Ginsberg G, Adunsky A, Rasooly I (2013) A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment. Hip Int 23:570–575
Miura LN, Di Piero AR, Homer LD (2009) Effects of a geriatrician-led hip fracture program: improvements in clinical and economic outcomes. J Am Geriatr Soc 57:159–167
Middleton M, Wan B, da Assunçao R (2017) Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing 46:465–470
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Katz S, Ford AB, Moskovitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919
González-Montalvo JI, Alarcón T, Mauleón JL, Gil-Garay E, Gotor P, Martín-Vega A (2010) The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip Int 20:229–235
Gupta A (2014) The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK. A. J R Coll Physicians Edinb 44:20–26
Friedman SM, Mendelson DA, Bingham KW, Kates SL (2009) Impact of a co-managed geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med 169:1712–1717
Gregersen M, Mørch MM, Hougaard K, Damsgaard EM (2012) Geriatric intervention in elderly patients with hip fracture in an orthopedic ward. J Inj Violence Res 4:45–51
Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR, Dimitri K, Marsh A (1998) The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care. Med J Aust 169:515–518
Vidán 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 53:1476–1482
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 14:27–31
Chong CP, Savige J, Lim WK (2009) Orthopaedic-geriatric models of care and their effectiveness. Australas J Ageing 28:171–176
Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, Hoang-Kim A, Mendelson D, Zuckerman J, Leung F, Burton J, Moran C, Parker M, Giusti A, Pioli G, Goldhahn J, Kates SL, Investigation performed with the assistance of the AOTrauma Network (2013) Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury 44:1403–1412
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 84:122–124
Gilchrist WJ, Newman RJ, Hamblen DL, Williams BO (1988) Prospective randomised study of an orthopaedic geriatric inpatient service. BMJ 297:1116–1118
Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E, Tomlinson G, O'Rourke K, Goldlist B (2002) Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. CMAJ 167:25–32
Kennie DC, Reid J, Richardson IR, Kiamari AA, Kelt C (1988) Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial. BMJ 297:1083–1086
Mendelson DA, Friedman SM (2014) Principles of comanagement and the geriatric fracture center. Clin Geriatr Med 30:183–189
Ventura C, Trombetti S, Pioli G, Belotti LM, De Palma R (2014) Impact of multidisciplinary hip fracture program on timing of surgery in the elderly patients. Osteoporos Int 25:2591–2597
Ho WW, Kwan Dai DL, Liu KW, Chow KM, Lau E, Woo J, Leung KS (2009) To investigate the effect and cost-effectiveness of implementing an orthogeriatric intervention for elderly patients with acute hip fracture: the experience in Hong Kong. J Am Geriatr Soc 57:2153–2154
Sirois MJ, Côté M, Pelet S (2009) The burden of hospitalized hip fractures: patterns of admissions in a level I trauma center over 20 years. J Trauma 66:1402–1410
Hagino H, Endo N, Harada A, Iwamoto J, Mashiba T, Mori S, Ohtori S, Sakai A, Takada J, Yamamoto T (2017) Survey of hip fractures in Japan: recent trends in prevalence and treatment. J Orthop Sci 22:909–914
Tarazona-Santabalbina FJ, Belenguer-Varea A, Rovira-Daudi E, Salcedo-Mahiques E, Cuesta-Peredó D, Doménech-Pascual JR, Salvador-Pérez MI, Avellana-Zaragoza JA (2012) Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality. Clinics 67:547–556
Boyd RV, Hawthorne J, Wallace WA, Worlock PH, Compton EH (1983) The Nottingham orthogeriatric unit after 1000 admissions. Injury 15:193–196
Barone A, Giusti A, Pizzonia M, Razzano M, Palummeri E, Pioli G (2006) A comprehensive geriatric intervention reduces short- and long-term mortality in older people with hip fracture. J Am Geriatr Soc 54:1145–1147
Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134:1261–1269
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Chen MC, Yang CT (2008) Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 63:92–97
Adunsky A, Lerner-Geva L, Blumstein T, Boyko V, Mizrahi E, Arad M (2011) Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment. J Am Med Dir Assoc 12:439–444
Rubenstein LZ (2004) Jospeph T freeman award lecture: comprehensive geriatric assessment: from miracle to reality. J Gerontol A Biol Sci Med Sci 59:473–477
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study was conducted in accordance with the declaration of Helsinki and approval was obtained from the ethics committee of the regional healthcare system with registration number 2257/14.
Conflicts of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baroni, M., Serra, R., Boccardi, V. et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 30, 907–916 (2019). https://doi.org/10.1007/s00198-019-04858-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-019-04858-2