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Bliemel C, Birkelbach R, Knauf T, Pass B, Craiovan B, Schoeneberg C, Ruchholtz S, Bäumlein M. Surgical management and outcomes following atypical subtrochanteric femoral fractures - results from a matched-pair analysis of the registry for geriatric trauma of the German Trauma Society. Arch Orthop Trauma Surg 2024; 144:2561-2572. [PMID: 38642159 PMCID: PMC11211164 DOI: 10.1007/s00402-024-05297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The outcomes of patients with atypical subtrochanteric fractures (ASFs) remain unclear. Data from a large international geriatric trauma registry were analysed to examine the outcome of patients with ASFs compared to patients with typical osteoporotic subtrochanteric fractures (TSFs). MATERIALS AND METHODS Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analysed. All patients treated surgically for ASFs or TSFs were included in this analysis. Across both fracture types, a paired matching approach was conducted, where statistical twins were formed based on background characteristics sex, age, American Society of Anesthesiologists (ASA) score and walking ability. In-house mortality and mortality rates at the 120-day follow-up, as well as mobility at 7 and 120 days, the reoperation rate, hospital discharge management, the hospital readmission rate at the 120-day follow-up, health-related quality of life, type of surgical treatment and anti-osteoporotic therapy at 7 and 120 days, were assessed as outcome measures using a multivariate logistic regression analysis. RESULTS Amongst the 1,800 included patients, 1,781 had TSFs and 19 had ASFs. Logistic regression analysis revealed that patients with ASFs were more often treated with closed intramedullary nailing (RR = 3.59, p < 0.001) and had a higher probability of vitamin D supplementation as osteoporosis therapy at 120 days (RR = 0.88, p < 0.002). Patients with ASFs were also more likely to live at home after surgery (RR = 1.43, p < 0.001), and they also tended to continue living at home more often than patients with TSFs (RR = 1.33, p < 0.001). Accordingly, patients with TSFs had a higher relative risk of losing their self-sufficient living status, as indicated by increased rates of patients living at home preoperatively and being discharged to nursing homes (RR = 0.19, p < 0.001) or other hospitals (RR = 0.00, p < 0.001) postoperatively. CONCLUSIONS Surgical treatment of ASFs was marked by more frequent use of closed intramedullary fracture reduction. Furthermore, patients with ASFs were more likely to be discharged home and died significantly less often in the given timeframe. The rate of perioperative complications, as indicated by nonsignificant reoperation rates, as well as patient walking abilities during the follow-up period, remained unaffected.
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Affiliation(s)
- Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany.
- Philipps University of Marburg, Marburg, Germany.
| | | | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Benjamin Craiovan
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
- Philipps University of Marburg, Marburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
- Philipps University of Marburg, Marburg, Germany
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Pavlović M, Bliemel C, Ketter V, Lenz J, Ruchholtz S, Eschbach D. Health-related quality of life (EQ-5D) after revision arthroplasty following periprosthetic femoral fractures Vancouver B2 and B3 in geriatric trauma patients. Arch Orthop Trauma Surg 2024; 144:2141-2148. [PMID: 38554206 PMCID: PMC11093848 DOI: 10.1007/s00402-024-05287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/10/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION The aim of this study was to determine the outcome parameters of revision arthroplasties for periprosthetic femoral fractures (PPFF) with a particular attention to quality of life (QoL) and mobility. MATERIALS AND METHODS Retrospective single-center study of PPFF with loose implants that underwent revision arthroplasty. Depending on individual patient characteristics, either an uncemented or cemented revision stem was chosen. Data collection included demographics, complications, clinical course and outcome parameters. Follow-up took place at least one year postoperatively. RESULTS Between 2008 and 2016, 43 patients could be included. Most patients (63%) were able to walk independently or with a walking aid after one year and amongst the surveyed patients 77% were able to reside at home. Concerning the QoL assessment, a high index of 0.8 ± 0.1 has been reached after one year. Mortality pointed out to be 9% after one year and 28% in general. CONCLUSION The treatment of PPFF remains challenging. Although complication rates and mortality are high in this frail collective of geriatric patients, revision arthroplasty leads to good postoperative results regarding mobility and quality of life.
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Affiliation(s)
- Melina Pavlović
- Center for Orthopedics and Trauma Surgery, University Hospital Gießen and Marburg, Philipps - Universität Marburg, 35043, Marburg, Germany.
| | - Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Gießen and Marburg, Philipps - Universität Marburg, 35043, Marburg, Germany
| | - Vanessa Ketter
- Center for Orthopedics and Trauma Surgery, University Hospital Gießen and Marburg, Philipps - Universität Marburg, 35043, Marburg, Germany
| | - Julia Lenz
- Center for Orthopedics and Trauma Surgery, University Hospital Gießen and Marburg, Philipps - Universität Marburg, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Gießen and Marburg, Philipps - Universität Marburg, 35043, Marburg, Germany
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Konstantinou P, Kostretzis L, Fragkiadakis G, Touchtidou P, Mavrovouniotis A, Davitis V, Ditsiou AZ, Gigis I, Nikolaides AP, Niakas D, Papadopoulos P, Ditsios K. Exploring Quality of Life and Mortality in Pertrochanteric Fragility Hip Fractures in Northern Greece: A Single Tertiary Center Study. J Clin Med 2024; 13:2478. [PMID: 38731006 PMCID: PMC11084555 DOI: 10.3390/jcm13092478] [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: 03/25/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Fragility-related pertrochanteric fractures have become a significant public health concern, with a rising incidence attributed to the expanding elderly demographic. Assessing patient-reported health-related quality of life (HRQoL), mortality, and factors correlated with them serves as a crucial metric in evaluating the effectiveness of hip fracture surgery. Methods: In a single-center retrospective study, 259 patients underwent surgical treatment with a cephalomedullary nail, with a mean follow-up of 21.7 months. Health-related quality of life (HRQoL) was assessed using SF-12 (12-item Short Form) and EQ-5D (EuroQoL-5 Dimensions) questionnaires. Mobility status was measured by the Crude Mobility Index (CMI). Surveys were administered during hospitalization and six months postoperatively. Statistical analysis involved descriptive statistics, non-parametric controls (Kendall, Mann-Whitney, and Wilcoxon), and Spearman correlation and logistic regression analysis, which were conducted using IBM SPSS version 28. Results: A statistically significant decrease was observed in the mean EQ-5D and SF-12 scores at 6 months post-op compared to the pre-fracture status. The ASA (American Society of Anaesthesiologists) score showed a significant correlation with the decrease in HRQoL measured by the SF-12 questionnaire. The 30-day post-operative mortality rate was 9.3%, increasing to 32.4% at 1 year. Notably, the 30-day mortality significantly rose during the pandemic era (5.0% vs. 12.0%; p = 0.003). Conclusions: Pertrochanteric hip fractures cause a lasting decline in quality of life. Annual mortality is high, and further investigations are needed to formulate policies that prevent hip fractures and reduce mortality rates.
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Affiliation(s)
- Panagiotis Konstantinou
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B7 5TE, UK;
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Georgios Fragkiadakis
- Healthcare Management, School of Social Science, Hellenic Open University, 263 35 Patra, Greece; (G.F.); (D.N.)
| | - Panagiota Touchtidou
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Argyrios Mavrovouniotis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Vasileios Davitis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Athina Zacharoula Ditsiou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Ioannis Gigis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | | | - Dimitris Niakas
- Healthcare Management, School of Social Science, Hellenic Open University, 263 35 Patra, Greece; (G.F.); (D.N.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Eth. Aminis 41, 546 35 Thessaloniki, Greece; (L.K.); (P.T.); (A.M.); (V.D.); (I.G.); (P.P.); (K.D.)
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Haddad BI, Abu Ali M, Alashkar O, Jamos D, Alnaser I, Qambar O, Aburumman R, Altarawneh D, Karam AM, Alshrouf MA. Quality of Life After Hip Fracture Surgery in the Elderly: A Cross-Sectional Study. Cureus 2024; 16:e52631. [PMID: 38374843 PMCID: PMC10876207 DOI: 10.7759/cureus.52631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Hip fractures are common and serious injuries as they lead to high mortality and morbidity and have a significant effect on patients' lives. Additionally, these injuries have substantial socioeconomic consequences for patients' quality of life, their families, and healthcare systems. The aim of this study is to assess the quality of life (QoL) in patients after hip fracture surgery. Methods This study involved a cross-sectional survey between February 2016 and December 2019, with a sample of 199 patients who suffered a hip fracture and were treated at a tertiary care teaching hospital. The participants completed the EuroQol 5-Dimensions 5-Levels (EQ-5D-5L) questionnaire. Pearson's chi-squared test, independent sample t-test, and Pearson's correlation coefficient (r) were used in the analysis. Results We found that there is a statistically significant association between age and having problems with mobility (p=0.023), self-care (p<0.001), and usual activity (p=0.029). In addition, increased age was significantly associated with decreased EuroQol Visual Analog Scale (EQ-VAS) scores (r=-0.213, p=0.003). We also found a statistically significant association between gender and self-care, as males were more likely to report having problems with self-care when compared to females (OR: 3.63; CI 95%: 1.77-7.44; p<0.001). Conclusion Mobility, self-care, and usual activity were the most significantly affected quality of life measures and were more apparent in older age groups. Patients should be educated about the possibility of a decline in their QoL and the role of postoperative rehabilitation in improving patients' mobility. Periodic QoL screening should be done as early as possible to detect any further decrease. Future research should standardize postoperative interview intervals to improve QoL evaluation and include a control group.
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Affiliation(s)
- Bassem I Haddad
- Department of Orthopedics, Jordan University Hospital, Amman, JOR
| | | | | | - Dana Jamos
- General Medicine, The University of Jordan, Amman, JOR
| | | | - Osama Qambar
- General Medicine, The University of Jordan, Amman, JOR
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Deutschbein J, Lindner T, Möckel M, Pigorsch M, Gilles G, Stöckle U, Müller-Werdan U, Schenk L. Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study. PeerJ 2023; 11:e14671. [PMID: 36942001 PMCID: PMC10024485 DOI: 10.7717/peerj.14671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/11/2022] [Indexed: 03/17/2023] Open
Abstract
Background Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes. Methods EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems. Results A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background. Conclusions Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.
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Affiliation(s)
- Johannes Deutschbein
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Tobias Lindner
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Martin Möckel
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Germany
| | - Gabriela Gilles
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculosceletal Surgery (CMSC), Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Germany
| | - Liane Schenk
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
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Gatot C, Shern-En Tan E, Liow MHL, Yongqiang Chen J, Png MA, Tan MH, Howe TS, Bee Koh JS. Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients. Geriatr Orthop Surg Rehabil 2021; 12:21514593211036252. [PMID: 34422439 PMCID: PMC8371729 DOI: 10.1177/21514593211036252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/04/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction The associated mortality and morbidity in hip fracture patients pose a major
healthcare burden for ageing populations worldwide. We aim to analyse how an
individual’s comorbidity profile based on age-adjusted Charlson Comorbidity
Index (CCI) may impact on functional outcomes and 90-day readmission rates
after hip fracture surgery. Materials and Methods Surgically treated hip fracture patients between 2013 and 2016 were followed
up for 1-year and assessed using Parker Mobility Score (PMS), EuroQol-5D
(EQ-5D) and Physical and Mental Component Scores (PCS and MCS, respectively)
of Short Form-36 (SF-36). Statistical analysis was done by categorising 444
patients into three groups based on their CCI: (1) CCI 0–3, (2) CCI 4–5 and
(3) CCI ≥ 6. Results PMS, EQ-5D and SF-36 PCS were significantly different amongst the CCI groups
pre-operatively and post-operatively at 3, 6 and 12 months (all
P < 0.05), with CCI ≥ 6 predicting for poorer
outcomes. In terms of 90-day readmission rates, patients who have been
readmitted have poorer outcome scores. Multivariate analysis showed that
high CCI scores and 90-day readmission rate both remained independent
predictors of worse outcomes for SF-36 PCS, PMS and EQ-5D. Discussion CCI scores ≥6 predict for higher 90-day readmission rates, poorer quality of
life and show poor potential for functional recovery 1-year post-operation
in hip fracture patients. 90-day readmission rates are also independently
associated with poorer functional outcomes. Peri-operatively, surgical teams
should liaise with medical specialists to optimise patients’ comorbidities
and ensure their comorbidities remain well managed beyond hospital discharge
to reduce readmission rates. With earlier identification of patient groups
at risk of poorer functional outcomes, more planning can be directed towards
appropriate management and subsequent rehabilitation. Conclusion Further research should focus on development of a stratified, peri-operative
multidisciplinary, hip-fracture care pathway treatment regime based on CCI
scores to determine its effectiveness in improving functional outcomes.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Evan Shern-En Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Meng Ai Png
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Abeygunasekara T, Lekamwasam S, Lenora J, Alwis G. Quality of Life and Functional Independence of Hip Fracture Patients: Data from a Single Center Follow-Up Study in Sri Lanka. Ann Geriatr Med Res 2021; 25:98-104. [PMID: 34120437 PMCID: PMC8273002 DOI: 10.4235/agmr.21.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Data on the functional outcomes of hip fracture patients in Sri Lanka are limited. As this information is required for the design of long-term care plans, we assessed the physical activities (activities of daily living [ADL]) and quality of life (QoL) of hip fracture survivors in Sri Lanka. Methods A group of 180 consecutive patients with incident hip fractures admitted to a tertiary care center in Southern Sri Lanka were followed up for 12 months. The Sinhala versions of the Barthel Index, 36-Item Short-Form Survey, and Mini-Mental State Examination were used to assess ADL, QoL, and mental status, respectively. Results Of the 180 patients (149 women), 107 underwent surgery. An initial sharp decline and partial recovery of ADL and QoL were observed among patients with hip fractures. Furthermore, patients who underwent surgical treatment showed faster recovery of ADL and QoL than did patients who were managed conservatively. Similarly, patients who did not have complications during the hospital stay showed faster recovery of ADL and QoL than did patients with one or more complications. Conclusions Hip fractures profoundly affected both ADL and QoL, and recovery remained incomplete at 12 months post fracture. Patients who underwent surgery had a faster recovery than did patients who did not undergo surgery; similarly, patients without complications also had a faster recovery than did those with complications.
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Affiliation(s)
- Thilina Abeygunasekara
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Sarath Lekamwasam
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Janaka Lenora
- Department of Physiology, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Gayani Alwis
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
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Sammut R, Azzopardi C, Camilleri L. Spiritual coping strategies and quality of life in older adults who have sustained a hip fracture: A cross-sectional survey. Nurs Open 2021; 8:572-581. [PMID: 33570284 PMCID: PMC7877164 DOI: 10.1002/nop2.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/20/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
AIMS To investigate the relationship between spiritual coping strategies and quality of life in persons with a hip fracture. DESIGN A correlational, cross-sectional survey design. METHODS The total population of Maltese-speaking adults over 65 years (N = 299), with a hip fracture receiving treatment in a public hospital in Malta in 2015, were invited. The WHOQOL-BREF questionnaire and the Spiritual Coping Strategies Scale were used. RESULTS A response rate of 51% (n = 147) was achieved. The poorest quality of life was for the physical and psychological domains. Spiritual coping strategies were associated with better quality of life with the exception of physical quality of life. Non-religious coping strategies were the stronger predictor of quality of life compared with religious coping strategies. The former predicted physical, psychological, environmental, social and overall quality of life. CONCLUSION Hip fractures have serious implications on quality of life which could be improved by promoting non-religious spiritual coping strategies.
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Affiliation(s)
| | | | - Liberato Camilleri
- Statistics and Operations ResearchFaculty of ScienceUniversity of MaltaMsidaMalta
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Zhang YW, Lu PP, Li YJ, Dai GC, Chen MH, Zhao YK, Cao MM, Rui YF. Prevalence, Characteristics, and Associated Risk Factors of the Elderly with Hip Fractures: A Cross-Sectional Analysis of NHANES 2005-2010. Clin Interv Aging 2021; 16:177-185. [PMID: 33542622 PMCID: PMC7851483 DOI: 10.2147/cia.s291071] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
Objective This cross-sectional study was aimed to update the assessment of prevalence, characteristics, and risk factors of the elderly with hip fractures in a non-institutionalized American population. Methods This current study included a total of 31,034 participants from the existing National Health and Nutritional Examination Survey (NHANES) database from 2005 to 2010, and 4,265 participants aged 65 years and older were ultimately identified. Their condition of hip fractures was determined by method of questionnaires according to the orthopedic surgeons' diagnosis, and related epidemiological and demographic data were further collected. The univariate analysis was used to screen the risk factors of hip fractures in the elderly, and the logistic regression model was established to conduct the multivariate analysis. Results Of the total 4,265 participants with clear information of hip fractures in elderly, 127 individuals with hip fractures were identified according to results of questionnaires, exhibiting a prevalence of 28.49 per 1,000 (95% confidence interval [CI]=21.38-35.60) for males and 31.03 per 1,000 (95% CI=23.72-38.35) for females. The mean age of the elderly with hip fractures was 77.12±5.88 years and tumble (48.0%) was the primary factor. In univariate analysis, age, race, smoking, drinking alcohol, and combined with osteoporosis were regarded as risk factors. Multivariate analysis showed that age (80 years and older), living alone, smoking, combined with diabetes and osteoporosis were the independent risk factors. Conclusion Our nationwide data indicate the prevalence of hip fractures in the elderly is generally on the rise, and the female occupies a higher proportion. Age (especially aged 80 years and older), race (mainly Non-Hispanic white), smoking, drinking alcohol, living alone, combined with diabetes and osteoporosis may be closely linked to the occurrence of hip fractures in the elderly, although these variables still need to be verified in further prospective investigations.
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Affiliation(s)
- Yuan-Wei Zhang
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Pan-Pan Lu
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Ying-Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Guang-Chun Dai
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Min-Hao Chen
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Ya-Kuan Zhao
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Mu-Min Cao
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Yun-Feng Rui
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu, People's Republic of China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
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10
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Changes in Health-Related Quality of Life for Older Persons With Cognitive Impairment After Hip Fracture Surgery: A Systematic Review. J Nurs Res 2021; 28:e97. [PMID: 31985559 DOI: 10.1097/jnr.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hip fractures in persons with cognitive impairments represent a major public health issue in older populations that often results in poor health-related quality of life (HRQoL). PURPOSE The aim of this systemic review was to examine the changes in HRQoL in older, cognitively impaired patients with hip fracture who had received surgical treatment. METHODS A literature search of PubMed, Scopus, MEDLINE, PsycINFO, and CINAHL (EBSCO) databases was conducted for studies published up to July 2018 that addressed the issue of HRQoL in cognitively impaired patients with hip fracture after surgery. Studies that met the following criteria were included: Patients with hip fracture were over 60 years old and had cognitive impairment or dementia, patients had undergone hip fracture repair surgery, HRQoL was determined using standardized questionnaires, a descriptive or interventional methodology was used, and the full-text article was available in English. RESULTS A primary search of databases yielded 1,528 studies, 621 duplicates were removed, and the remaining 907 abstracts were screened. Thirty-four full-text articles were deemed relevant for full review; of these, 10 articles met the criteria for inclusion in the review. Cognitive impairment was found to impact negatively on the patients' HRQoL after hip fracture surgery (n = 809). Severity of cognitive impairment was correlated with deterioration in HRQoL after hospital discharge. When compared with prefracture measures of HRQoL, the greatest deterioration in HRQoL postsurgery occurred during the first 4 months after discharge. Impacts on HRQoL for patients with cognitive impairment at later time points differed depending on type of hip fracture and type of surgical treatment. However, for most of the patients, HRQoL remained relatively unchanged at 6, 12, and 24 months postdischarge. CONCLUSIONS We recommend nursing care interventions for older persons with cognitive impairment be initiated immediately after surgery for hip fracture to prevent a significant decline in HRQoL. Further examination of interventions that are effective in maintaining HRQoL for these patients such as interdisciplinary care is necessary. In addition, the influences of hip fracture type and surgical approach on changes in HRQoL suggest a need for further investigations to determine what contributed to the observed inconsistencies in the outcomes.
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11
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What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial. J Orthop Trauma 2020; 34 Suppl 3:S29-S36. [PMID: 33027163 DOI: 10.1097/bot.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE Prognostic Level II.
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12
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Amarilla-Donoso FJ, López-Espuela F, Roncero-Martín R, Leal-Hernandez O, Puerto-Parejo LM, Aliaga-Vera I, Toribio-Felipe R, Lavado-García JM. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 2020; 18:71. [PMID: 32171319 PMCID: PMC7071575 DOI: 10.1186/s12955-020-01314-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hip fracture is an important social and medical problem due to its increasing prevalence, the consequences for health and the economic impact on the health care system, but there is no doubt that it also has repercussions on health-related quality of life (HRQoL). Hence the importance of understanding and determining the impact of the condition on everyday life from the perspective of the patient's physical, emotional and social well-being. PURPOSE To determine the impact of hip fracture on HRQoL of people over the age of 65 1 month after surgery, related factors and the effects on functional ability and mood. METHODS Prospective observational study conducted in the traumatology units of two university hospitals in the province of Cáceres with consecutive sampling of all patients over the age of 65 admitted for hip fracture surgery during the study period. Sociodemographic and clinical data were recorded at the time of admission and prospectively at the follow-up visit 1 month later. Clinical, social, quality of life (EQ-5D-), basic functional and instrumental capacity (Barthel Index (BI) and Lawton & Brody Scale), and geriatric depression (Yesavage) variables were collected. RESULTS The study included 224 patients with a median age of 84.6 years (SD ± 6.1), 76.3% were female. Charlson's comorbidity was 5.3 (SD ± 1.2). The EQ-5D index decreased from 0.62 (SD ± 0.35) to 0.16 at 1 month follow up (SD ± 0.20) p < 0.001. The mean Visual Analog Scale (VAS) score of EQ-5D decreased from 72.8 (SD ±15.8) to 48.3 (SD ± 17.2) p < 0.001. All dimensions of EQ-5D showed a significant reduction from the time of pre-fracture status to 1 month after surgery. Independent factors associated with HRQoL 1 month after surgery were pre-fracture status Barthel Index score, Lawton and Brody scale, presence of depression, and type of surgery. CONCLUSIONS After a hip fracture, patients experience considerable deterioration in their HRQoL, especially in self-care, daily activities, and mobility. There is also a significant decline in functional capacity for both the basic and instrumental activities of daily living. One month after surgery, HRQoL is a long way from pre-fracture levels.
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Affiliation(s)
| | - Fidel López-Espuela
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avda. De la Universidad S/N. CP: 10003, Caceres, Spain
| | - Raúl Roncero-Martín
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avda. De la Universidad S/N. CP: 10003, Caceres, Spain
| | - Olga Leal-Hernandez
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avda. De la Universidad S/N. CP: 10003, Caceres, Spain
| | - Luis Manuel Puerto-Parejo
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avda. De la Universidad S/N. CP: 10003, Caceres, Spain
| | - Ignacio Aliaga-Vera
- Department of Stomatology II, University of Madrid, Complutense, Madrid, Spain
| | | | - Jesús María Lavado-García
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Avda. De la Universidad S/N. CP: 10003, Caceres, Spain
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13
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Hlaing WY, Thosingha O, Chanruangvanich W. Health-related quality of life and its determinants among patients with hip fracture after surgery in Myanmar. Int J Orthop Trauma Nurs 2020; 37:100752. [PMID: 32029362 DOI: 10.1016/j.ijotn.2020.100752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hip fracture has been regarded as a significant international health problem because of its negative impacts on things such as Health-Related Quality of Life (HRQOL). The determinants of HRQOL among patients with hip fracture after surgery during transition of recovery are still not clearly understood. OBJECTIVE To study HRQOL factors and determine the predictive power of elements such as age, gender, co-morbid disease, Body Mass Index (BMI), depression or social support on HRQOL among patients with hip fracture after surgery in Myanmar. DESIGN Descriptive correlational predictive study. SETTING Yangon Orthopaedic Hospital and Mandalay Orthopaedic Hospital in Myanmar. RESULTS The mean age was 60 years (range = 18-91). The level of HRQOL at the 6th week after surgery was moderate. In stepwise multiple regression analysis, gender (β = -.109, p = .044), depressive symptoms (β = -.564, p = .000) and social support (β = .287, p = .000) were the determinants of HRQOL. These three factors accounted for 59.1% of variance to explain HRQOL. CONCLUSION In order to facilitate a healthy transition, comprehensive rehabilitation, including depressive symptoms screening and enhancing social support, and the health care services with less cost and psychosocial support especially for women, are recommended.
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Affiliation(s)
- Win Yadanar Hlaing
- Master of Nursing Science (International Program, Adult Health Nursing), Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Bangkok, 10700, Thailand.
| | - Orapan Thosingha
- Acting Associate Dean for Research Innovation and International Affair, Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Wallada Chanruangvanich
- Surgical Nursing Department, Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Bangkok, 10700, Thailand.
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14
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Balzer-Geldsetzer M, Buecking B, Ruchholtz S, Kis B, Dodel R, Hessmann P. Association between longitudinal clinical outcomes in patients with hip fracture and their pre-fracture place of residence. Psychogeriatrics 2020; 20:11-19. [PMID: 30920108 DOI: 10.1111/psyg.12450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/05/2019] [Accepted: 02/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home). METHODS Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale). RESULTS This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol-5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up-and-go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community-dwelling individuals and less improvement in functional and cognitive tests at 12-month follow-up. CONCLUSIONS Clinical outcomes after hip fracture are significantly associated with patients' pre-fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision-making.
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Affiliation(s)
- Monika Balzer-Geldsetzer
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Benjamin Buecking
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps-University Marburg, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Richard Dodel
- University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.,Department of Neurology, Philipps-University Marburg, Giessen, Germany
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
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15
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Hack J, Buecking B, Aigner R, Oberkircher L, Knauf T, Ruchholtz S, Eschbach D. What are the influencing factors in self-rated health status after hip fracture? A prospective study on 402 patients. Arch Osteoporos 2019; 14:92. [PMID: 31435743 DOI: 10.1007/s11657-019-0642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/12/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Health status (HS) and influencing factors in HS were evaluated six and 12 months after hip fracture. One-third of the patients did not reach their pre-fracture HS within 1 year. HS before fracture and fall risk could, inter alia, be identified as influencing factors. PURPOSE From a patient's perspective, regaining pre-fracture health status (HS) is one of the most important factors concerning the outcome after hip fracture. The aim of this study was to evaluate the HS and particularly to identify influencing factors in HS 6 and 12 months after hip fracture. METHODS A total of 402 patients with hip fractures aged 60 years and older were included. HS was evaluated using the EQ-5D questionnaire pre-fracture and at 6 and 12 months after surgery. Multivariate regression analysis was performed to identify influencing factors in HS at 6 and 12 months. Afterwards, the results in the EQ-5D index were dichotomized into worse and equal/better results than before fracture, and a multivariate logistic regression analysis was performed for the dichotomized variables at 6 and 12 months. RESULTS The EQ-5D index decreased from 0.71 before the fracture to 0.60 at 6 months (p < 0.001) and increased slightly to 0.63 at 12 months (p = 0.328). A high pre-fracture EQ-5D index was associated with not reaching the pre-fracture EQ-5D index, and a high Tinetti score at hospital discharge was associated with reaching the pre-fracture EQ-5D index at 6 and 12 months. A high ASA score was an influencing factor behind a lower EQ-5D index than before the fracture at 6 months. CONCLUSIONS Hip fractures constitute a deep and long-lasting drop in the patients' HS. Early and intensive physiotherapy and individualized rehabilitation programmes regarding a patient's living situation before the fracture seem to be essential to improve HS.
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Affiliation(s)
- Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany.
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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16
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Kruithof N, Haagsma JA, de Munter L, Polinder S, de Jongh MAC. Comparison of pre-injury recalled Health Status (HS) data of trauma patients and HS of the general population. Injury 2019; 50:890-897. [PMID: 30952497 DOI: 10.1016/j.injury.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Significant differences exist between retrospectively collected pre-injury Health Status (HS) of trauma patients and the HS of the general population. Compared to the general population, the trauma population includes a larger proportion of individuals with a low level of socio-economic status. The aim was to compare retrospectively collected pre-injury HS with HS of a sample of Dutch individuals not only adjusted for age and gender, but also for educational level. METHODS Within three months post-trauma, pre-injury HS (n = 2987) was collected by using the EuroQol-five-dimension-3-level (EQ-5D-3L) questionnaire. Data were abstracted from the Brabant Injury Outcome Surveillance. The reference cohort (n = 1839) included a sample of the Dutch general population. Multiple regression was used to compare HS of both cohorts. RESULTS A higher recalled pre-injury EQ-5D-3L score of the injury cohort was reported compared to the HS of the reference cohort after adjustment for age (β = 0.014 [95% CI: 0.001,0.027] for males and β = 0.018 [95% CI: -0.001, 0.036] for females). After adjustment for age and educational level, the Beta showed a ≥10% increasement: males; unadjusted β = 0.006 [95% CI: -0.007, 0.019] to β = 0.014 [95% CI: 0.001, 0.027] after age adjustment to β = 0.020 [95% CI: 0.007, 0.033] after adjustment for age and educational level, females; unadjusted β = -0.018 [95% CI: -0.035, -0.001] to β = 0.018 [95% CI: -0.001, 0.036] after age adjustments to β = 0.025 [95% CI: 0.007, 0.043] after adjustments for age and educational level. After adjustment for age, gender and educational level, the injury cohort reported prior to the trauma less problems on the 'pain/discomfort' (OR = 0.522 [95% CI: 0.454, 0.602]) and the 'anxiety/depression' (OR = 0.745 [95% CI: 0.619, 0.897]) dimensions, as compared to the reference cohort. In contrast, the injury cohort reported significantly more problems on the 'self-care' dimension (OR = 1.497 [95% CI: 0.1.112, 2.016]) prior to the trauma. CONCLUSIONS Injured patients report better recalled pre-injury HS compared to the HS of the reference cohort. After adjustment for educational level, the difference in HS between the injury cohort and the reference cohort increases, underlining that other confounders might also influence HS.
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Affiliation(s)
- Nena Kruithof
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands.
| | - Juanita A Haagsma
- Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands; Erasmus MC University Medical Centre, Department of Emergency Medicine, Rotterdam, the Netherlands
| | - Leonie de Munter
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands
| | - Suzanne Polinder
- Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands
| | - Mariska A C de Jongh
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
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17
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Mayoral AP, Ibarz E, Gracia L, Mateo J, Herrera A. The use of Barthel index for the assessment of the functional recovery after osteoporotic hip fracture: One year follow-up. PLoS One 2019; 14:e0212000. [PMID: 30730973 PMCID: PMC6366714 DOI: 10.1371/journal.pone.0212000] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
The Barthel index evolution was analyzed in a sample of older people with osteoporotic hip fracture in order to verify the influence of comorbidities and cognitive impairment on the physical recovery of those patients, during the first year following the fracture. A prospective observational study was carried out between October 1, 2012 and March 31, 2013. A sample of 247 individuals was initially selected. After a primary revision, 39 participants were excluded (clearly not meeting inclusion criteria, lack of data, or not agree to participate in the study), and finally a total of 208 participants were included in the analysis, 166 women, with an average age of 84.59 years, and 42 men, with an average age of 82.05. 54.80% of all cases were older than 85 years. The mean Barthel index value prior to fracture was 76.63, decreasing to 64.91 at one-year follow-up. Only 22.12% of patients achieved a full recovery for activities of daily living. A statistical analysis was performed by comparing Barthel index recovery depending on the values of Charlson and Pfeiffer indexes, respectively. The mean differences in Barthel index drop between the one-year follow-up and the hospital admission values were found statistical significant (p<0.01). These findings indicate that Charlson and Pfeiffer indexes clearly influence the Barthel index recovery. Low values of Charlson and Pfeiffer indexes resulted in better Barthel index recovery. In conclusion, the Barthel index is a good tool to evaluate the physical recovery after osteoporotic hip fracture.
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Affiliation(s)
- Ana P. Mayoral
- Health Sciences School, University of Zaragoza, Zaragoza, Spain
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragon Institute of Engineering Research, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragon Institute of Engineering Research, Zaragoza, Spain
| | - Jesús Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
| | - Antonio Herrera
- Aragon Institute of Engineering Research, Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- * E-mail:
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18
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Milte R, Crotty M, Miller MD, Whitehead C, Ratcliffe J. Quality of life in older adults following a hip fracture: an empirical comparison of the ICECAP-O and the EQ-5D-3 L instruments. Health Qual Life Outcomes 2018; 16:173. [PMID: 30185193 PMCID: PMC6126006 DOI: 10.1186/s12955-018-1005-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
Background The purpose of this study was to empirically compare the performance of two generic preference based quality of life instruments, EQ-5D-3 L (with a health and physical function focus) and ICECAP-O (with a wellbeing and capability focus), in a population of older Australians following hip fracture. Methods Older adults or their family member proxies (in cases of severe cognitive impairment) following surgery to repair a fractured hip were invited to take part in this cross sectional study. Inclusion criteria included an age of 60 years or older, confirmed falls-related hip fracture and those receiving current palliative care or consented to other research studies were excluded. 87 participants completed the ICECAP-O and EQ-5D-3 L instruments between one and three weeks post-surgery. Results For the hip fracture population, the mean ICECAP-O score was 0.639 (SD 0.206, n = 82) and the mean EQ-5D-3 L utility score was 0.545 (SD 0.251, n = 87). There was a statistically significant positive correlation between the ICECAP-O and EQ-5D-3 L scores (r = 0.529, p = < 0.001). Conclusions Study findings indicate significant impairments in quality of life post hip fracture. In multiple regression analyses, age and health-related QoL (measured by the EQ-5D) were significant determinants of ICECAP-O scores, while proxy respondent status, age, and capability-related QoL (measured by the ICECAP-O) were significant determinants of EQ-5D scores. Approaches to measuring and valuing quality of life in this sample, should consider the target domains of the intervention in their choice of instrument. Studies aiming to measure the impact of interventions targeting broader domains of wellbeing and QoL should consider including a broader measure of QoL in conjunction with a HRQoL measure.
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Affiliation(s)
- Rachel Milte
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia. .,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.
| | - Maria Crotty
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Michelle D Miller
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.,Flinders Clinical Effectiveness, Flinders University, Adelaide, SA, Australia
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Hack J, Eschbach D, Aigner R, Oberkircher L, Ruchholtz S, Bliemel C, Buecking B. Medical Complications Predict Cognitive Decline in Nondemented Hip Fracture Patients-Results of a Prospective Observational Study. J Geriatr Psychiatry Neurol 2018; 31:84-89. [PMID: 29562811 DOI: 10.1177/0891988718760240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to identify factors that are associated with cognitive decline in the long-term follow-up after hip fractures in previously nondemented patients. METHODS A consecutive series of 402 patients with hip fractures admitted to our university hospital were analyzed. After exclusion of all patients with preexisting dementia, 266 patients were included, of which 188 could be examined 6 months after surgery. Additional to several demographic data, cognitive ability was assessed using the Mini-Mental State Examination (MMSE). Patients with 19 or less points on the MMSE were considered demented. Furthermore, geriatric scores were recorded, as well as perioperative medical complications. Mini-Mental State Examination was performed again 6 months after surgery. RESULTS Of 188 previously nondemented patients, 12 (6.4%) patients showed a cognitive decline during the 6 months of follow-up. Multivariate regression analysis showed that age ( P = .040) and medical complications ( P = .048) were the only significant independent influencing factors for cognitive decline. CONCLUSIONS In our patient population, the incidence of dementia exceeded the average age-appropriate cognitive decline. Significant independent influencing factors for cognitive decline were age and medical complications.
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Affiliation(s)
- Juliana Hack
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Daphne Eschbach
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Rene Aigner
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Ludwig Oberkircher
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Steffen Ruchholtz
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Christopher Bliemel
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Benjamin Buecking
- 1 Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging 2018; 13:143-150. [PMID: 29416322 PMCID: PMC5790076 DOI: 10.2147/cia.s150067] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fractures due to fragility of the bone around the hip joint have become a major public health issue, presenting with an increasing incidence due to the growth of the elderly population. The purpose of this review was to evaluate the impact of hip fractures on the quality of life (QoL), health status (HS), functioning, and psychological parameters, and factors influencing the outcome and the appropriate interventions for improvement of elderly patients. A systematic electronic search of the relevant literature was carried out using the CINAHL, Cochrane, EMBASE, Medline (OvidSP), and PubMed databases spanning the time period from their establishment up to January 2017. Forty-nine randomized controlled trials or prospective cohort studies reporting the QoL and psychological outcomes were assessed by using standardized questionnaires. Patients with a hip fracture who were older than 65 years, were included in the analysis. In the majority of elderly patients, the hip fracture seriously affected physical and mental functioning and exerted a severe impact on their HS and health-related QoL (HRQoL). Moreover, most of the patients did not return to prefracture levels of performance regarding both the parameters. The levels of mental, physical, and nutritional status, prior to the fracture, comorbidity, and female gender, in addition to the postoperative pain, complications, and the length of hospital stay, were the factors associated with the outcome. Psychosocial factors and symptoms of depression could increase pain severity and emotional distress. For the displaced femoral neck fractures, the treatment with total hip arthroplasty or hemiarthroplasty, when compared to the treatment with internal fixation, provided a better functional outcome. Supportive rehabilitation programs, complemented by psychotherapy and nutritional supplementation prior to and after surgery, provided beneficial effects on the HS and the psychosocial dimension of the more debilitated patients’ lives. Lack of consensus concerning the most appropriate HRQoL questionnaires to screen and identify those patients with more difficulties in the psychosocial functions, demonstrates the necessity for further research to assess the newer outcome measurement tools, which might improve our understanding for better care of patients with hip fractures.
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Affiliation(s)
- Konstantinos I Alexiou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Andreas Roushias
- Orthopaedic Department, Apollonion Private Hospital, Nicosia, Cyprus
| | - Sokratis E Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
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Aigner R, Buecking B, Hack J, Eschbach D, Oberkircher L, Ruchholtz S, Bliemel C. Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients. Arch Osteoporos 2017; 12:32. [PMID: 28349470 DOI: 10.1007/s11657-017-0327-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year. PURPOSE The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated. METHODS Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed. RESULTS A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, -9.918; 95%CI of B, -19.001--0.835; p = 0.032) and on the Tinetti Test at 6 months (B, -2.914; 95%CI of B, -1.992--0.047; p = 0.047) and 12 months after surgery (B, -4.680; 95%CI of B, -8.042--1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052-3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010-9.529; p = 0.046). CONCLUSIONS Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.
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Affiliation(s)
- Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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22
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The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients. INTERNATIONAL ORTHOPAEDICS 2017; 41:1995-2000. [DOI: 10.1007/s00264-017-3591-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
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Scholten AC, Haagsma JA, Steyerberg EW, van Beeck EF, Polinder S. Assessment of pre-injury health-related quality of life: a systematic review. Popul Health Metr 2017; 15:10. [PMID: 28288648 PMCID: PMC5348891 DOI: 10.1186/s12963-017-0127-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022] Open
Abstract
Background Insight into the change from pre- to post-injury health-related quality of life (HRQL) of trauma patients is important to derive estimates of the impact of injury on HRQL. Prospectively collected pre-injury HRQL data are, however, often not available due to the difficulty to collect these data before the injury. We performed a systematic review on the current methods used to assess pre-injury health status and to estimate the change from pre- to post-injury HRQL due to an injury. Methods A systematic literature search was conducted in EMBASE, MEDLINE, and other databases. We identified studies that reported on the pre-injury HRQL of trauma patients. Articles were collated by type of injury and HRQL instrument used. Reported pre-injury HRQL scores were compared with general age- and gender-adjusted norms for the EQ-5D, SF-36, and SF-12. Results We retrieved results from 31 eligible studies, described in 41 publications. All but two studies used retrospective assessment and asked patients to recall their pre-injury HRQL, showing widely varying timings of assessments (soon after injury up to years after injury). These studies commonly applied the SF-36 (n = 13), EQ-5D (n = 9), or SF-12 (n = 3) using questionnaires (n = 14) or face-to-face interviews (n = 11). Two studies reported prospective pre-injury assessment, based on prospective longitudinal cohort studies from a sample of initially non-injured patients, and applied questionnaires using the SF-36 or SF-12. The recalled pre-injury HRQL scores of injury patients consistently exceeded age- and sex-adjusted population norms, except in a limited number of studies on injury types of higher severity (e.g., traumatic brain injury and hip fractures). All studies reported reduced post-injury HRQL compared to pre-injury HRQL. Both prospective studies reported that patients had recovered to their pre-injury levels of physical and mental health, while in all but one retrospective study patients did not regain the reported pre-injury levels of HRQL, even years after injury. Conclusions So far, primarily retrospective research has been conducted to assess pre-injury HRQL. This research shows consistently higher pre-injury HRQL scores than population norms and a recovery that lags behind that of prospective assessments, implying a systematic overestimation of the change in HRQL from pre- to post-injury due to an injury. More prospective research is necessary to examine the effect of recall bias and response shift. Researchers should be aware of the bias that may arise when pre-injury HRQL is assessed retrospectively or when population norms are applied, and should use prospectively derived HRQL scores wherever possible to estimate the impact of injury on HRQL. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0127-3) contains supplementary material, which is available to authorized users.
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Friess T, Hartwig E, Liener U, Sturm J, Hoffmann R. [Geriatric trauma centers from the idea to implementation. What has been achieved?]. Unfallchirurg 2017; 119:7-11. [PMID: 26601847 DOI: 10.1007/s00113-015-0114-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The geriatric trauma working party, a subgroup of the German Society of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU), focuses on the challenges of geriatric fractures, which are steadily increasing due to demographic changes. Inherent comorbidities implicate perioperative complications leading to loss of mobility and endangered independence followed by an increased burden on the social services. An interdisciplinary approach is required. The geriatric trauma working party defined criteria for interdisciplinary treatment and comprehensive care as well as early rehabilitation in interdisciplinary geriatric fracture centers. By passing an independent audit process these centers can achieve certification as a geriatric trauma center DGU (AltersTraumaZentrum DGU). Certified centers can participate in a recently established geriatric fracture registry which includes an internationally consented data set. Audit and registry enable centers to acquire an international benchmark, ensure permanent improvement in quality and allow participation in health services research.
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Affiliation(s)
- T Friess
- Zentrum für Orthopädie, Unfall- und Handchirurgie, Klinik für Unfall- und Handchirurgie, Katholisches Klinikum Oberhausen, St. Clemens Hospital, Wilhelmstr. 34, 46145, Oberhausen, Deutschland.
| | - E Hartwig
- Klinik für Orthopädie und Unfallchirurgie, Diakonissenkrankenhaus Karlsruhe, Karlsruhe, Deutschland
| | - U Liener
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Marienhospital Stuttgart, Stuttgart, Deutschland
| | - J Sturm
- Akademie der Unfallchirurgie (AUC) München, München, Deutschland
| | - R Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt am Main, Deutschland
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Neuerburg C, Gosch M, Blauth M, Böcker W, Kammerlander C. [Augmentation techniques on the proximal femur]. Unfallchirurg 2016; 118:755-64. [PMID: 26242546 DOI: 10.1007/s00113-015-0051-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Due to the demographic change fractures of the proximal femur are an increasing major healthcare problem and are associated with the highest mortality among frailty fractures. OBJECTIVES These mainly osteoporosis-associated fractures of the hip often represent a surgical challenge and the outcome has a decisive influence on the preservation of function and independency of orthogeriatric patients. Augmentation techniques could improve the stability of osteosynthesis in proximal femoral fractures. METHODS Cement augmentation of proximal femoral nailing (PFNA) for the treatment of pertrochanteric femoral fractures is the most commonly used and standardized method of augmentation for these fractures by which a safer condition for immediate full weight bearing and mobilization can be achieved. RESULTS In biomechanical and clinical studies good fracture healing was shown and there was no evidence of cement-associated complications in augmented PFNA nailing. In the majority of patients the mobility level prior to trauma could be achieved. CONCLUSION In addition to the optimal surgical treatment, secondary prevention such as osteoporosis management to avoid further fractures is crucial in the treatment of these patients. This article is based on the current literature and provides an overview of the possible applications of cement augmentation for the treatment of proximal femoral fractures. In addition the surgical approach as well as previous scientific data on an established osteosynthesis using cement-augmented PFNA for the treatment of pertrochanteric frailty fractures are presented.
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Affiliation(s)
- C Neuerburg
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland,
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26
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Aigner R, Meier Fedeler T, Eschbach D, Hack J, Bliemel C, Ruchholtz S, Bücking B. Patient factors associated with increased acute care costs of hip fractures: a detailed analysis of 402 patients. Arch Osteoporos 2016; 11:38. [PMID: 27815914 DOI: 10.1007/s11657-016-0291-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of the present study was to identify patient factors associated with higher costs in hip fracture patients. The mean costs of a prospectively observed sample of 402 patients were 8853 €. The ASA score, Charlson comorbidity index, and fracture location were associated with increased costs. PURPOSE Fractures of the proximal end of the femur (hip fractures) are of increasing incidence due to demographic changes. Relevant co-morbidities often present in these patients cause high complication rates and prolonged hospital stays, thus leading to high costs of acute care. The aim of this study was to perform a precise cost analysis of the actual hospital costs of hip fractures and to identify patient factors associated with increased costs. METHODS The basis of this analysis was a prospectively observed single-center trial, which included 402 patients with fractures of the proximal end of the femur. All potential cost factors were recorded as accurately as possible for each of the 402 patients individually, and statistical analysis was performed to identify associations between pre-existing patient factors and acute care costs. RESULTS The mean total acute care costs per patient were 8853 ± 5676 € with ward costs (5828 ± 4294 €) and costs for surgical treatment (1972 ± 956 €) representing the major cost factors. The ASA score, Charlson comorbidity index, and fracture location were identified as influencing the costs of acute care for hip fracture treatment. CONCLUSION Hip fractures are associated with high acute care costs. This study underlines the necessity of sophisticated risk-adjusted payment models based on specific patient factors. Economic aspects should be an integral part of future hip fracture research due to limited health care resources.
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Affiliation(s)
- R Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany.
| | - T Meier Fedeler
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - D Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - J Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - B Bücking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
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27
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Haywood KL, Brett J, Tutton E, Staniszewska S. Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability. Qual Life Res 2016; 26:799-812. [DOI: 10.1007/s11136-016-1424-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/24/2023]
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29
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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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30
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Moerman S, Vochteloo AJH, Tuinebreijer WE, Maier AB, Mathijssen NMC, Nelissen RGHH. Factors associated with the course of health-related quality of life after a hip fracture. Arch Orthop Trauma Surg 2016; 136:935-43. [PMID: 27236585 DOI: 10.1007/s00402-016-2474-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The number of hip fracture patients is expected to grow the forthcoming decades. Knowledge of the impact of the fracture on the lives of elderly could help us target our care. The aim of the study is to describe HRQoL (Health-Related Quality of Life) after a hip fracture and to identify factors associated with the course of HRQoL in the first postoperative year. MATERIALS AND METHODS 335 surgically treated hip fracture patients (mean age 79.4 years, SD 10.7, 68 % female) were included in a prospective observational cohort. HRQoL was measured with the SF-12 Health Survey, composed of the Physical and a Mental Component Summary Score (PCS, MCS), at admission (baseline) and at 3 and 12 months postoperatively. Eleven predefined factors known to be associated with the course of HRQoL were recorded: age, gender, physical status, having a partner at admission, living in an institution, prefracture level of mobility, anemia, type of fracture and treatment, delirium during hospital stay and length of stay. RESULTS HRQoL declined between baseline and 3 months, and recovered between three and 12 months. PCS HRQoL did not recover to baseline values, MCS HRQoL did. Age younger than 80 years, ASA classification I and II, higher prefracture level of mobility, intracapsular fracture and treatment with osteosynthesis (compared to arthroplasty) were associated with greater initial decline in PCS HRQoL, none of the recorded factors were significant for decline in MCS HRQoL. CONCLUSIONS Both PCS and MCS HRQoL declined after a hip fracture and PCS did not recover to baseline values. Healthier patients may need extra care to prevent them from having a steep decline in postoperative PCS HRQoL and arthroplasty should be considered with low threshold.
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Affiliation(s)
- Sophie Moerman
- Department of Orthopedic Surgery, Reinier de Graaf Group, Reinier de Graafweg 3-11, 2625, AD, Delft, The Netherlands.
| | - Anne J H Vochteloo
- Centre for Orthopedic Surgery OCON, Geerdinksweg 141, 7555, DL, Hengelo, The Netherlands
| | - Wim E Tuinebreijer
- Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Andrea B Maier
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Centre, De Boelelaan 1117, 1007, MB, Amsterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopedic Surgery, Reinier de Graaf Group, Reinier de Graafweg 3-11, 2625, AD, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopedic Surgery Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
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Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 2016; 27:1979-87. [PMID: 26733375 DOI: 10.1007/s00198-015-3472-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcome of patients with hip fracture remains disappointing. This study determined four prognostic factors (lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender) to predict 1-year survival in patients with hip fracture. INTRODUCTION This study determined the prognostic factors for 1-year survival in patients with hip fracture. Based on these predictors, a scoring system was developed for use upon patients' admission to the hospital. METHODS Hip fracture patients, aged ≥60 years, were prospectively enrolled. Upon admission, patients' sociodemographic data, type of fracture, American Society of Anesthesiologists (ASA) score, health-related quality of life scores (EQ-5D index) and Mini-Mental State Examination (MMSE) scores were recorded, among other parameters. Correlational analysis was performed on all potential variables to identify relevant predictor variables of 1-year survival. Univariate regression analysis was performed on all selected variables, followed by a multivariate analysis for variables that were significant in the univariate analysis. The final score was developed by converting the β-coefficients of each variable from the multivariate analysis into a scoring system. RESULTS For 391 hip fracture patients, complete data were available at the time of the 1-year follow-up. In multivariate regression analysis, independent predictors of 1-year survival were lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender. The different variables were weighted according to their β-coefficient to build the prognostic score, which ranged from 0 to 10 points. The ROC curve for 1-year mortality after hip fracture showed an area under the curve of 0.74 (R (2) = 0.272; 95 % CI 0.68-0.79; p < 0.001). CONCLUSIONS With only four instruments, the new score represents a useful tool for estimating 1-year survival in elderly patients with hip fractures. At present, the score is limited due to a lack of validation. A validation study is currently underway to prove its reliability.
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Affiliation(s)
- C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - R Sielski
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - B Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - R Dodel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Balzer-Geldsetzer
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - B Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Orive M, Anton-Ladislao A, García-Gutiérrez S, Las Hayas C, González N, Zabala J, Quintana JM. Prospective study of predictive factors of changes in pain and hip function after hip fracture among the elderly. Osteoporos Int 2016; 27:527-36. [PMID: 26243365 DOI: 10.1007/s00198-015-3267-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Our study identified pre-fracture variables, such as home status or function, that are directly or indirectly associated with frailty status before fracture. The prevention in the deterioration of those variables would improve the prognosis of those hip fractured, being this an important issue for the societies with increasingly aging population. INTRODUCTION This study was designed to identify predictors of pain and declines in function among elderly patients following a fall-related hip fracture. METHODS Patients aged 65 or older with a fall-related hip fracture retrospectively completed pre-fracture status questionnaires (T0; n = 740) and were then prospectively followed for 6 months (T1; n = 546). Of these, 474 were randomly selected to complete an additional 18 months of follow-up (T2; n = 356). Primary outcome measures were changes in the pain and function dimensions of the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire's short form (WOMAC-SF). Potential predictors included sociodemographic variables, in-hospital and clinical pre- and post-fracture data, and activities of daily living at baseline and follow-up. Multivariate logistic regression was used for analysis. RESULTS Predictors of worsening pain at T1 and/or T2 included living in a home care situation or nursing home before the fracture (OR at T1, 1.515; OR at T2, 2.749), and low pre-fracture pain (OR at T1, 1.028; OR at T2, 1.027). Predictors of deterioration in function at T1 and/or T2 included age ≥85 years (OR at T1, 2.714; OR at T2, 4.762), lower income (OR at T1, 1.755), high pre-fracture hip function (OR at T1, 1.029; OR at T2, 1.028), referral to rehabilitation upon discharge (OR at T1, 2.378; OR at T2, 2.881), and longer delay between fall and surgery (OR at T1, 1.133; OR at T2, 1.124). CONCLUSIONS Frailty before hip fracture is a predictor of greater post-fracture pain and deterioration in function. Given that exercise programs help prevent frailty, promoting exercise in elderly may improve the prognosis of hip fracture.
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Affiliation(s)
- M Orive
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain.
| | - A Anton-Ladislao
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - S García-Gutiérrez
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - C Las Hayas
- Psychology Department of Personality, Assessment and Treatment, University of Deusto, Bilbao, 48007, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - N González
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - J Zabala
- Traumatology Service, Galdakao-Usansolo Hospital, Galdakao, 48960, Bizkaia, Spain
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
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Hansson S, Rolfson O, Åkesson K, Nemes S, Leonardsson O, Rogmark C. Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients. Injury 2015; 46:2206-11. [PMID: 26298023 DOI: 10.1016/j.injury.2015.07.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. METHODS All patients (>20 years, non-pathological fracture, residents in the catchment area, n=664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. RESULTS The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24h, p<0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. CONCLUSION General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process.
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Affiliation(s)
- Susanne Hansson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Kristina Åkesson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Szilard Nemes
- Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Olof Leonardsson
- Department of Orthopaedics, Blekinge Hospital, Karlskrona, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden; Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
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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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Factors influencing the progress of mobilization in hip fracture patients during the early postsurgical period?—A prospective observational study. Arch Gerontol Geriatr 2015; 60:457-63. [DOI: 10.1016/j.archger.2015.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 11/22/2022]
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