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Buehring B, Maus U. [Geriatric traumatological management of osteoporosis : "Let the first fracture be the last"]. Z Gerontol Geriatr 2024:10.1007/s00391-024-02370-9. [PMID: 39373920 DOI: 10.1007/s00391-024-02370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 09/10/2024] [Indexed: 10/08/2024]
Abstract
In Germany more than 800,000 osteoporotic fractures occur every year, with severe medical, social and health economic consequences. Nevertheless, as in many other countries there is a large gap in care. Fractures frequently occur in older geriatric patients, who are increasingly being (or should be) treated in geriatric trauma centers. This multidisciplinary approach offers the opportunity not only to restore the patient's mobility and independence but also to set the course for preventing further fractures. Diagnosing osteoporosis and initiating treatment early after a fracture is particularly important as there is an imminently high risk of further fractures in the months and years following a fracture. This review article describes a pragmatic, guideline-based approach to osteoporosis management for geriatric trauma patients. It discusses fracture risk assessment, current treatment thresholds and treatment strategies as well as the individual osteoporosis drugs, the indications and contraindications. This review aims to show that the treatment of osteoporosis within the framework of a geriatric traumatology team is feasible in the majority of cases. It is suggested that a treatment decision can be systematically made based on a few questions or a flow chart.
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Affiliation(s)
- Bjoern Buehring
- Bergisches Rheuma-Zentrum, Cellitinnen Krankenhaus St. Josef, Wuppertal, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
- Abteilung für Rheumatologie, Immunologie und Osteologie, Cellitinnen Krankenhaus St. Josef, Bergstr. 6-12, 42105, Wuppertal, Deutschland.
| | - Uwe Maus
- Endoprothetik und Osteologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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2
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Keppler AM, Gosch M, Kammerlander C. Orthogeriatric co-management in pelvic and acetabular fractures. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05566-1. [PMID: 39325163 DOI: 10.1007/s00402-024-05566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Osteoporosis, age and frailty significantly impacts outcomes in fragility fractures of the pelvis, increasing morbidity and mortality. Identifying frailty aids in risk stratification and personalized care plans, enhancing recovery and reducing complications in older adults. Orthogeriatric co-management, an interdisciplinary approach combining orthopedics and geriatrics, optimizes care for older adults with fragility fractures. This model improves outcomes through integrated preoperative and postoperative care. This study examines the current literature for orthogeriatric co-management in pelvic ring or acetabular fractures, aiming to improve outcomes for older adults. CONCLUSION Orthogeriatric co-management can be an effective tool to significantly enhances clinical care and reduces complications in older adults with pelvic ring and acetabular fractures. Studies demonstrate increased detection of urological complications and earlier patient mobilisation, alongside a notable decrease in revision surgery rates. The implementation of a specialized framework underscores the necessity for standardised orthogeriatric protocols, optimizing patient outcomes and satisfaction. Integrating geriatric expertise in surgical treatment addresses comorbidities more effectively and minimizes postoperative complications. The certification of such centers ensures adherence to quality standards, fostering continuous improvement in care. Standardised orthogeriatric management should extend to all older fracture patients.
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Affiliation(s)
- Alexander Martin Keppler
- Musculoskeletal University Center Munich (MUM), LMU Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Markus Gosch
- Department of Medicine 2/ Geriatrics, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
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3
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Pinter G. [Geriatric assessment goes digital-Possible applications in the emergency department setting]. Z Gerontol Geriatr 2024:10.1007/s00391-024-02360-x. [PMID: 39294390 DOI: 10.1007/s00391-024-02360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/15/2024] [Indexed: 09/20/2024]
Abstract
The geriatric assessment is a basic requirement and a key quality parameter in geriatric care. An increasing number of older patients are presenting to emergency or central admission departments and discharge units in hospitals. For this reason, and in view of the time-critical decision-making requirements in this setting, digital applications of basic geriatric assessment data are becoming increasingly more important for the high-quality follow-up care of geriatric patients.
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Affiliation(s)
- Georg Pinter
- Zentrum für Altersmedizin (Abteilung für Akutgeriatrie/Remobilisation, geriatrische Tagesklinik, Abteilung für Chronisch Kranke, Spezialambulanz für Demenzerkrankungen und Geriatrischer Konsiliardienst), Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich.
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Roos J, Ben Amar S, Weinhold L, Zellner AA, Touet A, Prangenberg C, Loy T, Gathen M. Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany. Clin Pract 2024; 14:789-800. [PMID: 38804395 PMCID: PMC11130787 DOI: 10.3390/clinpract14030063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. MATERIAL AND METHODS A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. RESULTS The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. CONCLUSIONS This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.
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Affiliation(s)
- Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Soufian Ben Amar
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Leonie Weinhold
- Institute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Alberto Alfieri Zellner
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Amadeo Touet
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Christian Prangenberg
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Thomas Loy
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
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Pass B, Knauf T, Knobe M, Rascher K, Bliemel C, Maslaris A, Aigner R, Dirkmann D, Lendemans S, Schoeneberg C. Spinal anesthesia with better outcome in geriatric hip fracture surgery - An analysis of the Registry for Geriatric Trauma (ATR-DGU). Injury 2023:S0020-1383(23)00298-X. [PMID: 37032184 DOI: 10.1016/j.injury.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Literature shows conflicting results regarding spinal (SA) or general anesthesia (GA) and their influence on the outcome of elderly patients with hip fractures. We, therefore, conducted an analysis from the Registry for Geriatric Trauma (ATR-DGU). METHODS A retrospective, multicenter registry study including patients aged 70 years or above with hip fractures requiring surgery from 131 Centers for Geriatric Trauma (AltersTraumaZentrum DGU®) from 2016 to 2021. Patients with SA or GA were compared using matched-pair analysis and linear and logistic regression models. RESULTS A total of 43,714 patients were included, of whom 3,242 received SA. The median age was 85 (SA) and 84 years (GA). Adjustments for the American Society of Anesthesiologists (ASA) grade, sex, age, additional injuries, and anticoagulation resulted in a higher in-hospital (odds ratio (OR) 1.31; 95% confidence interval [CI], 1.07 - 1.61, p = 0.009) and 120 days mortality (OR 1.47; 95% CI, 1.1 - 1.95, p = 0.009) in the GA group. GA had a significant negative influence on walking ability seven days after surgery and on the quality of life (QoL). The length of hospital stay (LoS) was significantly shorter in the SA group. CONCLUSIONS SA is associated with a higher survival rate, a better walking ability seven days after surgery, a higher QoL, and a shorter LoS.
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Affiliation(s)
- Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - Tom Knauf
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - Matthias Knobe
- Medical Faculty, University of Zurich, Zurich, Switzerland; Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany.
| | | | - Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - Alexander Maslaris
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - Daniel Dirkmann
- Department of Anesthesiology, Intensive Care and Pain Medicine, Alfried Krupp Hospital Essen, Germany.
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
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Neumann CJ, Schulze-Raestrup U, Müller-Mai CM, Smektala R. [Development of the inpatient quality of care of surgically treated patients with a proximal femoral fracture in North Rhine-Westphalia : Analysis of 61,249 treatment courses based on data from external inpatient quality assurance]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:634-646. [PMID: 34328519 PMCID: PMC9349128 DOI: 10.1007/s00113-021-01065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Every year in Germany over 100,000 people, mostly of older age, suffer a proximal femoral fracture. Increasing case numbers in connection with an aging population and a relatively large number of concomitant diseases requiring treatment make everyday care more difficult. It is therefore of great importance to observe the quality of care for these patients using relevant quality parameters in order to be able to derive implications for everyday treatment practice. MATERIAL AND METHODS The data of the external inpatient quality assurance from North Rhine-Westphalia for the years 2007-2008 and 2017-2018 were analyzed and the time periods compared. In addition, based on the documented secondary diagnosis and other influencing parameters, a risk adjustment was carried out with the aid of a logistic regression model with respect to the outcomes of general and surgical complications and mortality. Both osteosynthetically and endoprosthetically treated patients were taken into account. A total of 61,249 cases were included in the study. RESULTS Positive developments could be observed in the area of surgical complications and wound infections with decreases of 1.2% and 0.8%, respectively. Patients with cardiovascular diseases had a particularly poor outcome. Here, improvements in the subcategory of cardiovascular events were found for general complications. The mortality remained unchanged at 6%. Operative activity on the weekends increased significantly. Patients whose hospital admission was related to the weekend did not show an increased risk of complications or mortality. Although the proportion of patients who were operated on after more than 48 h was reduced from 11.4% to 8.2%, the operation (> 24 h) was still delayed in 26.8% of cases. CONCLUSION Against the background of increasing performance demands on the healthcare system, the results document improvements in some central areas of inpatient treatment. Nevertheless, the development of strategies for the further reduction of the preoperative waiting times in a medically justifiable manner is required. Internal concomitant diseases have a decisive influence on patient outcome. Thus, an adequate treatment of the multimorbid patient collective is to be established in everyday practice on the basis of close cooperation between geriatric traumatology and geriatric internal medicine departments.
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Affiliation(s)
- C J Neumann
- Klinik für Unfallchirurgie und Orthopädie, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinikum der Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland.
| | - U Schulze-Raestrup
- Qualitätssicherung NRW, Ärztekammer Westfalen-Lippe, Münster, Deutschland
| | - C M Müller-Mai
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Klinikum Lünen, Lünen, Deutschland
| | - R Smektala
- Klinik für Unfallchirurgie und Orthopädie, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinikum der Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland
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7
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Koehl P, Pelk K, Necula R, Goyal T, Abbas K, Schuh A. [Hip fractures in the elderly - what should be done to achieve early recovery?]. MMW Fortschr Med 2022; 164:40-48. [PMID: 35941450 DOI: 10.1007/s15006-022-1217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Philipp Koehl
- Klinik für Orthopädie und Unfallchirurgie/Hand-/Wirbelsäulenchirurgie, Klinikum Fichtelgebirge, Schillerhain 1-8, 95615, Marktredwitz, Deutschland.
| | - Kerstin Pelk
- Klinik für Akutgeriatrie, Klinikum Fichtelgebirge, 95100, Selb, Deutschland
| | - Radu Necula
- Klinik für Orthopädie und Traumatologie, Universität Transilvania Brașov, 500036, Brașov, Rumänien
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, Indien
| | - Kashif Abbas
- Trauma and Orthopaedics, University Hospital Southampton, Southampton, UK
| | - Alexander Schuh
- Abteilung für Muskuloskelettale Forschung, Klinikum Fichtelgebirge gGmbH - Haus Marktredwitz, Marktredwitz, Deutschland
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8
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Hafner T, Kollmeier A, Laubach M, Knobe M, Hildebrand F, Pishnamaz M. Care of Geriatric Patients with Lumbar Spine, Pelvic, and Acetabular Fractures before and after Certification as a Geriatric Trauma Center DGU ®: A Retrospective Cohort Study. MEDICINA-LITHUANIA 2021; 57:medicina57080794. [PMID: 34441000 PMCID: PMC8398181 DOI: 10.3390/medicina57080794] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
Background: More than 750,000 fragility fractures occur in Germany every year, with an expected increase in the following years. Interdisciplinary care pathways for geriatric patients are increasingly established to improve the treatment process and outcome, but there has been only limited evaluation of their use. Objectives: This study aimed to compare patient care before and after the implementation of a geriatric trauma center (GTC) in conformity with the German Society for Trauma Surgery (DGU®). Patients and Methods: We performed a retrospective single-center cohort study, including 361 patients >70 years old with lumbar spine, pelvic, and acetabular fractures, admitted between January 2012 and September 2019. Patients were divided into a usual care cohort (UC, n = 137) before implementation and an ortho-geriatric care cohort (OGC, n = 224) after implementation of the GTC DGU®. We recorded and compared demographic data, fracture type, geriatric assessment and management, therapy, complications, and various clinical parameters, e.g., length of stay, time to surgery, hours admitted to ICU, and change in walking ability. Results: The geriatric assessment revealed significant geriatric co-morbidities and a need for geriatric intervention in 75% of the patients. With orthogeriatric co-management, a significant increase in the detection of urological complications (UC: 25.5% vs. OGC: 37.5%; p = 0.021), earlier postoperative mobilization (UC: 57.1% vs. OGC: 86.3%; p < 0.001), an increased prescription of anti-osteoporotic treatment at discharge (UC: 13.1% vs. OGC: 46.8%; p < 0.001), and lower rates of revision surgery (UC: 5.8% vs. OGC: 3.1%; p = 0.012) could be seen. Conclusions: Our results emphasize the improvement in patient care and clinical outcome by implementing a GTC DGU® and provide opportunities for future improvement in ortho-geriatric patient care.
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Affiliation(s)
- Tobias Hafner
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany; (A.K.); (M.L.); (F.H.); (M.P.)
- Correspondence: ; Tel.: +49-241-8035024
| | - Alina Kollmeier
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany; (A.K.); (M.L.); (F.H.); (M.P.)
| | - Markus Laubach
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany; (A.K.); (M.L.); (F.H.); (M.P.)
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital, 6004 Lucerne, Switzerland;
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany; (A.K.); (M.L.); (F.H.); (M.P.)
| | - Miguel Pishnamaz
- Department of Trauma and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany; (A.K.); (M.L.); (F.H.); (M.P.)
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Bücking B, Neuerburg C, Knobe M, Liener U. [Treatment of patients with fragility fractures]. Unfallchirurg 2019; 122:755-761. [PMID: 31428807 DOI: 10.1007/s00113-019-00707-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fragility fractures are fractures in multimorbid, geriatric patients. Currently, their number is already high and is likely to increase in the future. OBJECTIVE This article gives an overview of the principles in the management of patients with fragility fractures. MATERIAL AND METHODS A selective literature review was performed to describe the epidemiology and relevance of fragility fractures. In addition, the principles of the perioperative management and surgical treatment of patients with fragility fractures are shown. RESULTS Due to the significant number of comorbidities, the treatment of patients with fragility fractures represents an interdisciplinary challenge. Ideally, treatment should be carried out in an interdisciplinary team under the leadership of orthopedic surgeons and geriatricians. Treatment should be based on consensus guidelines, which have been adapted to the local circumstances. Attention should be paid to some special aspects of the surgical treatment in this vulnerable patient cohort. Important are optimal soft tissue management, cement augmentation procedures and joint replacement in cases of periarticular fractures. CONCLUSION There is evidence that with optimal care the treatment of patients with fragility fractures can be significantly improved.
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Affiliation(s)
- B Bücking
- Klinik für Orthopädie, Unfallchirurgie und Alterstraumatologie, DRK-Kliniken Nordhessen Gemeinnützige GmbH, Standort Wehlheiden, Hansteinstr. 29, 34121, Kassel, Deutschland.
| | - C Neuerburg
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - M Knobe
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - U Liener
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Vinzenz von Paul Kliniken gGmbH Marienhospital Stuttgart, Stuttgart, Deutschland
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10
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Knobe M, Böttcher B, Coburn M, Friess T, Bollheimer LC, Heppner HJ, Werner CJ, Bach JP, Wollgarten M, Poßelt S, Bliemel C, Bücking B. [Geriatric Trauma Center DGU®: Evaluation of clinical and economic parameters : A pilot study in a german university hospital]. Unfallchirurg 2019; 122:134-146. [PMID: 29675629 DOI: 10.1007/s00113-018-0502-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). METHODS A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). RESULTS In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracture patients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). CONCLUSION There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracture patients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.
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Affiliation(s)
- M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - B Böttcher
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Coburn
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - T Friess
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie im St. Clemens-Hospital Oberhausen, Oberhausen, Deutschland
| | - L C Bollheimer
- Lehrstuhl für Altersmedizin, RWTH Aachen mit Klinik für Innere Medizin und Geriatrie am Franziskushospital Aachen, Aachen, Deutschland
| | - H J Heppner
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland
| | - C J Werner
- Klinik für Neurologie, Sektion Interdisziplinäre Geriatrie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J-P Bach
- Klinik für Neurologie, Sektion Interdisziplinäre Geriatrie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - M Wollgarten
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - S Poßelt
- Kaufmännisches Controlling, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - C Bliemel
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | - B Bücking
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
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11
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König-Leischnig A, Klewer J, Karich B, Richter K. [Elderly trauma patients with proximal femur fractures : Statistical evaluation of regular process data from a trauma center for the elderly]. Unfallchirurg 2019; 120:667-674. [PMID: 27369184 DOI: 10.1007/s00113-016-0196-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Proximal femoral fractures are one of the most frequently occurring injuries among elderly people. High rates of inpatient treatment indicate the importance of optimized clinical care. OBJECTIVES Based on selected outcome parameters in elderly trauma patients with proximal femoral fractures, the current situation of medical care in a trauma center for geriatric patients is presented. METHODS For a descriptive evaluation of outcome parameters, 250 patients aged 70 years and older have been included. A clinical register of a trauma center for the elderly served as the database. RESULTS The average length of stay was approximately 25 days. Sixty-seven percent of the patients underwent surgical treatment within 24 h of admission to the hospital. More than half of the patients were taking anticoagulant drugs. Around 18 % of patients presented with one or more complications. Mortality rate was 5.2 %. Thirty-two percent of those patients who had been living at home before admission had been discharged to a nursing home. DISCUSSION AND CONCLUSIONS Analyzing the data of a trauma registry enables critical reflection upon the clinical outcome of interdisciplinary treatment procedures. The low rate of mortality may be a result of the geriatric co-treatment, starting right from admission. It remains unclear whether the influence of preoperative interdisciplinary treatment outweighs the effect of a timely surgical procedure.
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Affiliation(s)
- A König-Leischnig
- Fakultät für Gesundheits- und Pflegewissenschaften, Westsächsische Hochschule Zwickau, Zwickau, Deutschland. .,Alterstraumazentrum, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland. .,Klinik für Unfallchirurgie und Physikalische Medizin, Heinrich-Braun-Klinikum Zwickau, Karl-Keil-Straße 35, 08060, Zwickau, Deutschland.
| | - J Klewer
- Fakultät für Gesundheits- und Pflegewissenschaften, Westsächsische Hochschule Zwickau, Zwickau, Deutschland
| | - B Karich
- Alterstraumazentrum, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland.,Klinik für Unfallchirurgie und Physikalische Medizin, Heinrich-Braun-Klinikum Zwickau, Karl-Keil-Straße 35, 08060, Zwickau, Deutschland
| | - K Richter
- Alterstraumazentrum, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland
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12
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Carow J, Carow JB, Coburn M, Kim BS, Bücking B, Bliemel C, Bollheimer LC, Werner CJ, Bach JP, Knobe M. Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2371-2380. [PMID: 28921003 DOI: 10.1007/s00264-017-3639-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/03/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Despite intense research and innovations in peri-operative management, a high mortality rate and frequent systemic complications in trochanteric femoral fractures persist. The aim of the present study was to identify predictive factors for mortality and cardio-respiratory complications after different treatment methods in a ten year period at a level I trauma centre. METHODS Retrospectively, all patients above 60 years of age with trochanteric femoral fracture between January 2000 and May 2011 were analyzed at a level I trauma centre. Demographic variables, comorbidities, and data regarding the surgical procedures, including required transfusions and post-operative complications, were evaluated, and the in-hospital mortality was recorded. The grade of osteoporosis was classified radiographically using the Singh index. RESULTS The in-hospital mortality rate was 8.2% among 437 patients (male/female ratio = 110/327, mean age = 81 years) with extramedullary open (n = 144), intramedullary (n = 166), and extramedullary minimally invasive (n = 125) procedures. Significant influential factors on in-hospital mortality were identified with binary logistic regression analysis: an age of ≥90 years (P = 0.011), male sex (P = 0.003), a high American Society of Anesthesiologists (ASA) grade (3-5, P = 0.042), and a high osteoporosis grade (Singh index 3-1, P = 0.011). A total of 21.5% of the study population suffered cardio-respiratory complications post-operatively. The specific mortality was 28.7% (P < 0.001), which was influenced by a high ASA grade (3-5, P = 0.002) and a high transfusion rate (P = 0.004). Minimally invasive locked plating was associated with increased cardio-respiratory complications (P = 0.031). CONCLUSIONS This study identified high patient age, distinctive comorbidities, male sex, and high osteoporosis grade as significant risk factors for increased in-hospital mortality in the treatment of trochanteric femoral fractures. Furthermore, high ASA grade and a liberal transfusion regime led to an increased incidence of cardio-respiratory complications. Patient-specific characteristics, especially osteoporosis grade and pre-existing medical conditions, may assist in the identification of high-risk patients and allow a patient-specific geriatric co-management plan.
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Affiliation(s)
- Juliane Carow
- RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany
| | - John Bennet Carow
- RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany
| | - Mark Coburn
- RWTH Aachen University Hospital, Department of Anaesthesiology, Aachen, Germany
| | - Bong-Sung Kim
- RWTH Aachen University Hospital, Department of Plastic Surgery, Hand Surgery - Burn Center, Aachen, Germany
| | - Benjamin Bücking
- University Hospital Gießen and Marburg GmbH, Campus Marburg, Department of Trauma, Hand and Reconstructive Surgery, Marburg, Germany
| | - Christopher Bliemel
- University Hospital Gießen and Marburg GmbH, Campus Marburg, Department of Trauma, Hand and Reconstructive Surgery, Marburg, Germany
| | | | - Cornelius Johannes Werner
- RWTH Aachen University Hospital, Department of Neurology, Section of Interdisciplinary Geriatric Medicine, Aachen, Germany
| | - Jan Philipp Bach
- RWTH Aachen University Hospital, Department of Neurology, Section of Interdisciplinary Geriatric Medicine, Aachen, Germany
| | - Matthias Knobe
- RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany.
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13
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Bücking B, Hartwig E, Nienaber U, Krause U, Friess T, Liener U, Hevia M, Bliemel C, Knobe M. [Results of the pilot phase of the Age Trauma Registry DGU®]. Unfallchirurg 2017. [PMID: 28643096 DOI: 10.1007/s00113-017-0370-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since 2014, hospitals with ortho-geriatric fracture centres could be certified as AltersTraumaZentrum DGU® in Germany. To measure the quality of treatment in these centres, a geriatric trauma registry (AltersTraumaRegister DGU®) was established. OBJECTIVES The aim of this work was to report the results of the pilot phase of the AltersTraumaRegister DGU® from the year 2015. MATERIALS AND METHODS Included were 118 patients >70 years with hip fracture or implant-related femoral fractures. Apart from other parameters, the point of surgery, initiation of anti-osteoporotic treatment and the EQ-5D one week post-surgery was measured. RESULTS Surgery was performed in 87% of patients within 24 h. Specific osteoporotic therapy could be increased from 4 to 63 patients. The EQ-5D was strongly restricted to one week post-surgery. CONCLUSION Based on the timing of surgery and anti-osteoporotic therapy, the treatment seems to be successful in the ortho-geriatric fracture centres. For a better evaluation of treatment quality in the AltersTraumaZentren DGU®, implementation of follow-up examinations in the AltersTraumaRegister DGU® is essential.
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Affiliation(s)
- Benjamin Bücking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, Marburg, Deutschland.
| | - Erich Hartwig
- Klinik für Orthopädie und Unfallchirurgie, Diakonissenkrankenhaus Karlsruhe, Karlsruhe, Deutschland
| | - Ulrike Nienaber
- AUC - Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - Ulla Krause
- AUC - Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - Thomas Friess
- Zentrum für Orthopädie, Unfall- und Handchirurgie, St. Clemens Hospital, Katholisches Klinikum Oberhausen, Oberhausen, Deutschland
| | - Ulrich Liener
- Klinik für Orthopädie und Unfallchirurgie, Marienhospital Stuttgart, Stuttgart, Deutschland
| | - Maria Hevia
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, Marburg, Deutschland
| | - Christopher Bliemel
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, Marburg, Deutschland
| | - Matthias Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland
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14
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Buecking B, Eschbach D, Bliemel C, Knobe M, Aigner R, Ruchholtz S. [Endoprostheses in geriatric traumatology]. DER ORTHOPADE 2016; 46:48-53. [PMID: 27966179 DOI: 10.1007/s00132-016-3369-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. OBJECTIVE The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. MATERIAL AND METHODS A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). RESULTS The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. CONCLUSION The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.
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Affiliation(s)
- B Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - D Eschbach
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - C Bliemel
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - R Aigner
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - S Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
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15
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Stadler C, Gosch M, Roth T, Neuerburg C, Kammerlander C. [Interdisciplinary management in geriatric trauma surgery : Results of a survey in Austria]. Unfallchirurg 2016; 120:761-768. [PMID: 27577088 DOI: 10.1007/s00113-016-0231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The treatment of geriatric patients in the field of trauma surgery is increasingly gaining importance. To provide optimized treatment to these mostly multimorbid patients, interdisciplinary treatment concepts between trauma surgeons and geriatricians have been designed and implemented successfully. OBJECTIVES The aim of this survey was to evaluate the current state of interdisciplinary management in the treatment of geriatric patients on trauma surgery wards throughout Austria. MATERIAL AND METHODS The directors of 64 Austrian trauma surgery wards were surveyed using an online-questionnaire regarding the current interdisciplinary treatment of geriatric patients. RESULTS A total of 39 (61 %) questionnaires were analyzed. Of the participating wards, 20 % distinguished between geriatric and non-geriatric patients. There were various criteria to classify the patients. The average percentage of patients older than 70 years was 43 %. Of the participating wards, 26 % had established a periodical cooperation between trauma surgeons and geriatricians and 8 % of the participants stated that there is no interdisciplinary cooperation. The establishment of an interdisciplinary treatment concept in the near future was planned in 28 %. The most commonly mentioned obstacle that prevented trauma surgery wards from establishing an interdisciplinary management model was the lack of personnel resources (59 %) - especially the lack of geriatricians (62 %). CONCLUSION The survey's results underline the geriatric trauma surgery's great importance especially regarding the high percentage of geriatric patients, as well as the fact that the significance of the interdisciplinary cooperation between trauma surgeons and geriatricians is not yet perceived by the majority of Austrian trauma surgery wards.
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Affiliation(s)
- C Stadler
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - M Gosch
- Klinikum Nürnberg, Medizinische Klinik 2 - Geriatrie, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - T Roth
- Univ.-Klinik für Unfallchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - C Neuerburg
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - C Kammerlander
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, Marchioninistr. 15, 81377, München, Deutschland.,Univ.-Klinik für Unfallchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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16
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[The Academy of Trauma Surgery (AUC). Service provider and management organization of the DGU]. Unfallchirurg 2016; 119:164-72. [PMID: 26838594 DOI: 10.1007/s00113-015-0140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and training, e.g. advanced trauma life support (ATLS®) and other training programs including the innovative interpersonal competence (IC) course.
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[Interdisciplinary treatment in geriatric traumatology from the trauma surgeons' perspective : Results of a survey in Germany]. Unfallchirurg 2015; 120:32-39. [PMID: 26070733 DOI: 10.1007/s00113-015-0027-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many patients treated on trauma surgery wards are geriatric trauma patients. To improve treatment of these often multimorbid patients, various interdisciplinary treatment concepts have been established in Germany between trauma surgeons and geriatricians. OBJECTIVES The aim of this study was to evaluate the dissemination and the impact of the different orthogeriatric treatment concepts for geriatric trauma in Germany. Material and methods In March and April 2014 an electronic questionnaire for assessing the interdisciplinary treatment of geriatric trauma patients was sent to 691 medical directors of trauma surgery departments in Germany. RESULTS A total of 259 (37 %) fully answered questionnaires could be analyzed. The analysis revealed that 70 % of all responding trauma surgery departments had an orthogeriatric treatment cooperation. Most of them reported having patient discharge agreements to geriatric rehabilitation facilities (59 %). Geriatric counseling services were reported by 39 % while 24 % reported having regular interdisciplinary visits and orthogeriatric wards were available in 13 %. The need for orthogeriatric services was considered to be high by 79 % of the participants and benefits especially for the patients were expected. These expectations were largely fulfilled. More than 70 % of respondents planned to intensify the orthogeriatric cooperation. In this context difficulties were seen in the lack of personnel resources, especially in a lack of geriatricians. CONCLUSION The results of this survey underline the impact and the positive experiences in orthogeriatric services. Solutions have to be found to address the emerging problem of capacity constraints.
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