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Pablos-Hernández C, González-Ramírez A, da Casa C, Luis MM, García-Iglesias MA, Julián-Enriquez JM, Rodríguez-Sánchez E, Blanco JF. Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models. Orthop Surg 2020; 12:457-462. [PMID: 32167674 PMCID: PMC7189046 DOI: 10.1111/os.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients. Methods We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post‐surgical stay, and in‐hospital mortality according to the healthcare model applied. Results Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A‐B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in‐hospital follow‐up, there was a reduction in in‐hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance. Conclusions The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically‐treated patients.
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Affiliation(s)
- Carmen Pablos-Hernández
- Unidad de Ortogeriatría, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Alfonso González-Ramírez
- Unidad de Ortogeriatría, Hospital Universitario de Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Maria Margarida Luis
- Servicio de Medicina Interna, Centro Hospitalario de Vila Nova de Gaia, Espinho, Portugal
| | | | | | - Emiliano Rodríguez-Sánchez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Unidad de Investigación en Atención Primaria, Salamanca, Spain
| | - Juan F Blanco
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Salamanca, Salamanca, Spain
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de Miguel Artal M, Roca Chacón O, Martínez-Alonso M, Serrano Godoy M, Mas Atance J, García Gutiérrez R. [Hip fracture in the elderly patient: Prognostic factors for mortality and functional recovery at one year]. Rev Esp Geriatr Gerontol 2018; 53:247-254. [PMID: 29929867 DOI: 10.1016/j.regg.2018.04.447] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture. MATERIALS AND METHODS Longitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality. RESULTS The baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery. CONCLUSION In the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission.
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Affiliation(s)
- Mariano de Miguel Artal
- Servicio de Geriatría, Hospital Universitari Santa María-Gestió de Serveis Sanitaris, Lleida, España.
| | - Olga Roca Chacón
- Servicio de Geriatría, Hospital Universitari Santa María-Gestió de Serveis Sanitaris, Lleida, España
| | - Montse Martínez-Alonso
- Unidad de Bioestadística (BioStat, IRBLLeida) y Ciencias Médicas Básicas, Universitat de Lleida (UdL), Lleida, España
| | - Marcos Serrano Godoy
- Servicio de Geriatría, Hospital Universitari Santa María-Gestió de Serveis Sanitaris, Lleida, España
| | - Jaume Mas Atance
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - Roberto García Gutiérrez
- Servicio de Geriatría, Hospital Universitari Santa María-Gestió de Serveis Sanitaris, Lleida, España
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Fernández-Ibáñez J, Morales-Ballesteros M, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes M, Cruz-Tejado J, Hernández-Zegarra P, Arias-Arias Á, García-Baltasar M. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes MD, Cruz-Tejado J, Hernández-Zegarra PA, Arias-Arias Á, García-Baltasar MM. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:88-95. [PMID: 28214194 DOI: 10.1016/j.recot.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.
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Affiliation(s)
- J M Fernández-Ibáñez
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - M C Morales-Ballesteros
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - E Crespo-Romero
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - S Gómez-Gómez
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M D Fraga-Fuentes
- Servicio de Farmacia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Cruz-Tejado
- Servicio de Anestesia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P A Hernández-Zegarra
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Á Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M M García-Baltasar
- Servicio de Trabajo Social, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Sánchez-Hernández N, Sáez-López P, Paniagua-Tejo S, Valverde-García J. Results following the implementation of a clinical pathway in the process of care for elderly patients with osteoporotic hip fracture in a second level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mesa-Lampré M, Canales-Cortés V, Castro-Vilela M, Clerencia-Sierra M. Initial experiences of an orthogeriatric unit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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[Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:1-11. [PMID: 26493233 DOI: 10.1016/j.recot.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/16/2015] [Accepted: 08/17/2015] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. MATERIAL AND METHODS A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. RESULTS The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. CONCLUSION The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.
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Sáez López P, Sánchez Hernández N, Paniagua Tejo S, Valverde García JA, Montero Díaz M, Alonso García N, Freites Esteve A. [Clinical pathway for hip fracture patients]. Rev Esp Geriatr Gerontol 2015; 50:161-167. [PMID: 25559411 DOI: 10.1016/j.regg.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. PURPOSE To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. MATERIAL AND METHODS A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. RESULTS Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. CONCLUSION The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.
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Affiliation(s)
- Pilar Sáez López
- Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España.
| | | | | | | | - Margarita Montero Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Noelia Alonso García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Alfonso Freites Esteve
- Servicio de Cardiología. Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Mesa-Lampré MP, Canales-Cortés V, Castro-Vilela ME, Clerencia-Sierra M. [Initial experiences of an orthogeriatric unit]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:429-38. [PMID: 25920894 DOI: 10.1016/j.recot.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To report the design and outcomes obtained during the first operational years of the Orthogeriatric Unit (OGU) established in the Zaragoza-1 (Spain) Health-Sector. MATERIAL AND METHODS A total of 494 patients >70 years old treated in the OGU from February 2009 to December 2012. An analysis was performed using the following variables: demography, previous functional level, comorbidities, surgical delay, fracture type and surgical technique, complications, hospital stay, functional outcomes, destination after hospital discharge, and short and long term mortality. RESULTS Mean age 85.22 years. High incidence of comorbidities (Charlson Index): 24.3%. Dementia: 38.5%. Surgical delay: 2.57 days. Mean hospital stay between admission and discharge/transfer to convalescence unit, 20.9 days (Traumatology 6.45+OGU 14.49). More than a third (34.6%) of patients suffered from delirium. Mean functional improvement (Barthel index at hospital discharge-Barthel index at hospital admission): 27.25 points. Montebello index: 0.49. In-hospital mortality: 6.9%. CONCLUSION Hip fracture is such a frequent and disabling pathology among the geriatric population that its treatment requires an interdisciplinary approach. This must be managed by the geriatrician, who has to assure the continuity and integration of the diverse treatment and care schedules, with the participation of the entire professional team in the decision-making process. We are very satisfied with the creation of our interdisciplinary Unit that enables us to report competitive outcomes. We believe that the progression of this Unit from providing subacute to acute care will improve the general outcomes in the future.
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Affiliation(s)
- M P Mesa-Lampré
- Servicio de Geriatría, Unidad de Ortogeriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - V Canales-Cortés
- Servicio de Cirugía Ortopédica y Traumatología, Sector Zaragoza 1, Unidad de Ortogeriatría, Hospitales Royo Villanova y Nuestra Señora de Gracia, Zaragoza, España.
| | | | - M Clerencia-Sierra
- Unidad de Valoración Sociosanitaria, Hospital Universitario Miguel Servet, Zaragoza, España
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Pareja Sierra T, Rodriguez Solis J. Tratamiento médico perioperatorio del anciano ingresado por fractura de cadera. Med Clin (Barc) 2014; 143:455-60. [DOI: 10.1016/j.medcli.2014.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/29/2022]
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The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care. ACTA ACUST UNITED AC 2014. [DOI: 10.1017/s0959259814000100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.
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González-Montalvo JI, Alarcón Alarcón T. [Orthogeriatrics in acute patients: to act, but also assess and compare as a way to improve]. Rev Esp Geriatr Gerontol 2014; 49:101-2. [PMID: 24656718 DOI: 10.1016/j.regg.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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de Miguel Artal M, Roca Chacón O. [Intervention by a geriatric interdisciplinary health and welfare unit (UFISS) in patients with hip fractures admitted to a Traumatology Department]. Rev Esp Geriatr Gerontol 2014; 49:96-97. [PMID: 24060410 DOI: 10.1016/j.regg.2013.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/09/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Mariano de Miguel Artal
- Unidad Funcional Interdisciplinar Sociosanitaria de Geriatría, Gestió de Serveis Sanitaris, Hospital Santa María, Lleida, España.
| | - Olga Roca Chacón
- Unidad Funcional Interdisciplinar Sociosanitaria de Geriatría, Gestió de Serveis Sanitaris, Hospital Santa María, Lleida, España
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Wagner P, Fuentes P, Diaz A, Martinez F, Amenabar P, Schweitzer D, Botello E, Gac H. Comparison of complications and length of hospital stay between orthopedic and orthogeriatric treatment in elderly patients with a hip fracture. Geriatr Orthop Surg Rehabil 2013; 3:55-8. [PMID: 23569697 DOI: 10.1177/2151458512450708] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hip fractures in the elderly individuals are a complex problem. Our objective was to determine whether orthogeriatric treatment is effective in terms of reducing length of hospital stay, morbidity, and mortality of elderly patients with a hip fracture compared with orthopedic (traditional) treatment. From July 2009 to May 2011, patients older than 65 years with a hip fracture were followed prospectively. They were co-treated by geriatric and orthopedic teams. This cohort was compared with a retrospective cohort followed from January 2007 to June 2009 that was managed by the orthopedic surgery team only. Epidemiology, pre- and postoperative hematocrit, and renal function were registered. Also, in-hospital and distant mortality data (determined by consulting the national registry), mortality-associated factors, postoperative complications, hospital stay length, and transfers to other services were registered. One hundred and eighty-three patients in the retrospective group and 92 in the prospective group were included in this study with a median follow-up of 26 months (interquartile range: 13-41). The average age was 84 years and 74% of patients were female. Intertrochanteric fracture accounted for 51% of the cases. There was no difference between groups with regard to hospital stay length, hematocrit at discharge, in-hospital mortality, long-term survival, or transfers to internal medicine or the intensive care unit. It did show differences in the transfer to the intermediate care unit, prolonged hospitalizations (>20 days), and diagnosis of delirium and anemia requiring transfusion. In the present study, orthogeriatric treatment is slightly more effective than traditional treatment in terms of morbidity, but there is no difference in hospital stay length or mortality. Further studies and longer follow-up are needed to draw more conclusions.
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Affiliation(s)
- Pablo Wagner
- Department of Orthopedic Surgery, Catholic University of Chile, Santiago, Chile
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Bielza Galindo R, Ortiz Espada A, Arias Muñana E, Velasco Guzmán de Lázaro R, Mora Casado A, Moreno Martín R, Tapia Salinas B, Escalera Alonso J, Gómez Cerezo J. [Opening of an Acute Orthogeriatric Unit in a general hospital]. Rev Esp Geriatr Gerontol 2013; 48:26-29. [PMID: 23141626 DOI: 10.1016/j.regg.2012.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 03/02/2012] [Accepted: 03/08/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients with hip fracture (HF), due to their characteristics, require a specific support. The Acute Orthogeriatric Unit (OGU) has been shown to be one of the most beneficial. OBJECTIVE To evaluate the main variables of HF patients treated at an OGU and compare them with the previous referral model (RC). MATERIAL AND METHODS A prospective observational study with retrospective control was conducted on 169 patients, split into two groups. In the RC group, patients were admitted to conventional trauma ward. In the OGU group, an early geriatric assessment was performed, and patients were simultaneously attended daily by the orthopaedic surgeon, nurse and geriatrician, and the surgery times, work load, discharge and destination, were planned in a weekly meeting with the rest of professionals. RESULTS A total of 71 patients were included in the RC group and 96 in the OGU group. The preoperative characteristics were similar, except for a slightly higher comorbidity in the OGU group. The OGU patients were operated on earlier (3.82±2.08 vs 4.61±2.5 days; P<.32), and overall hospital stay was reduced by 28% (11.84±4.04 vs 16.46±8.4 days; P<.001). The functional efficiency (Barthel Index at discharge-Barthel Index at admission/overall stay - stay before surgery) was higher in the OGU group (1.56±0.7 vs 2.61±1.1; P<.05). There were no differences in functional status, mortality or discharge location. CONCLUSIONS The OGU is a level of care that provides effective medical care in HF patients in general hospitals.
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Affiliation(s)
- Rafael Bielza Galindo
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
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[Hip fracture guidelines. A comparison of the main recommendations]. Rev Esp Geriatr Gerontol 2012; 47:220-7. [PMID: 22858132 DOI: 10.1016/j.regg.2012.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/04/2011] [Accepted: 02/21/2012] [Indexed: 11/23/2022]
Abstract
Hip fracture is the most severe complication of osteoporosis, and despite being a frequent health problem, there is a wide variability in both the health care provided to these patients and the results achieved after their treatment. Clinical guidelines are a tool that helps to reduce this variability. The authors of this review try to give a panoramic and comparative view of the key recommendations proposed by the main guidelines for the hospital care of hip fracture patients. Recommendations on the care in the acute phase are reviewed, particularly the initial hospital management, use of tools, preventive measures to avoid medical complications, surgery related aspects, treatment of usual clinical problems, and shared orthopaedic and geriatric care. Circulating and putting into practice the main recommendations will help to improve the health care provided to these patients and obtain better outcomes.
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Duaso E, Marimón P, Sosa JC, Vega D, Navarro A, Escalante E, Vilaseca M, Bausili JM, Sellarés R. [Eleven months of caring for patients with a fractured femur in an Acute Geriatric Unit]. Rev Esp Geriatr Gerontol 2012; 47:132-3. [PMID: 22264750 DOI: 10.1016/j.regg.2011.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 09/09/2011] [Accepted: 09/14/2011] [Indexed: 11/30/2022]
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Gotor Pérez P. [Multidisciplinary approach to hip fractures. The importance of nursing in the new health care models]. Rev Esp Geriatr Gerontol 2011; 46:287-288. [PMID: 22030217 DOI: 10.1016/j.regg.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 05/31/2023]
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González Montalvo JI, Gotor Pérez P, Martín Vega A, Alarcón Alarcón T, Álvarez de Linera JLM, Gil Garay E, García Cimbrelo E, Alonso Biarge J. [The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. Rev Esp Geriatr Gerontol 2011; 46:193-199. [PMID: 21507529 DOI: 10.1016/j.regg.2011.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/14/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. METHOD Prospective quasy-experimental randomized intervention study in 506 patients admitted to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. RESULTS Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneously by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P < .05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P < .001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48 ± 5 vs 18.9 ± 8.6 days, P < .001) (median 12 [9-14] vs 17 [13-23] days, P < .001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ± 14.7 vs 23.9 ± 13.8 days, P < 0.05) (median 14 [10-31] vs 20 [14-30] days, P < .001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. CONCLUSIONS The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.
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González Montalvo JI, Alarcón Alarcón T, Pallardo Rodil B, Gotor Pérez P, Pareja Sierra T. [Acute orthogeriatric care (II). Clinical aspects]. Rev Esp Geriatr Gerontol 2008; 43:316-329. [PMID: 18842206 DOI: 10.1016/s0211-139x(08)73574-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventions to be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristics of several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcome improvement and the need for more efficient resource use in patients in the acute phase of hip fracture.
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